Tenn. Comp. R. & Regs. 1200-11-03-.06 - PROVIDERS

(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.

Notes

Tenn. Comp. R. & Regs. 1200-11-03-.06

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 12/5/2016.

Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-12-101 et seq., and § 42 U.S.C. 701(a).