- (1) All providers shall be appropriately certified and/or licensed in their respective specialties.
- (2) Providers participating in a TennCare Managed Care Organization (MCO) network shall be recognized by the program as providers and must complete an application to the program for reimbursement purposes. Providers not participating in a TennCare MCO network must complete an application and be approved to serve as a provider before submitting any costs for reimbursement.
- (3) All providers must sign the Department’s vendor agreement and abide by these rules.
- (4) Providers shall not submit additional and concurrent charges to the family for the care of a child over and above the amount covered by third party payors, as provided in these rules. This does not preclude a family or other party from making a contribution toward the care of the child when they are willing and able but providers shall not solicit or accept such contributions from the family of a child on TennCare for services covered in whole or in part by TennCare.
- (5) No provider shall charge program enrolled children more than the amount charged for private clients for equivalent accommodations and services.
Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and § 42 U.S.C. 701(a). Administrative History: Original rule filed December 30, 1983; effective January 29, 1984. Amendment filed May 29, 1990; effective July 13, 1990. Repeal and new rule filed March 21, 2000; effective July 28, 2000. Repeal and new rule filed October 9, 2002; effective December 23, 2002. Repeal and new rules filed September 6, 2016; effective December 5, 2016.