TennCare Appeals

Do you think that TennCare made a mistake? Are you still waiting for TennCare to tell you if you are eligible? Did TennCare say that you can’t get the medicines your doctor ordered? You can appeal, which might fix these problems. There are two kinds of appeals: an eligibility appeal, and a service appeal.

Eligibility Appeal

File an eligibility appeal if:

  • You applied for TennCare on the Marketplace more than 45 days ago, or applied for CHOICES more than 90 days ago, and you still have not heard from TennCare if you are eligible or not.
  • The start date for your coverage is wrong.
  • You were denied coverage.
  • Your Patient Liability amount is wrong.
  • Your coverage ended or is ending.
  • You have any other problem with TennCare that is about your eligibility.

If you fit into any of the above categories, you should appeal. You can appeal by:

  • Sending in this appeal form to Tennessee Health Connections.
    • You can fax it to 1-855-315-0669. Keep the fax receipt.
    • Or, you can mail it to: Tennessee Health Connections, P.O. Box 305240, Nashville, TN 37230-5240.
  • Calling Tennessee Health Connections at 1-855-259-0701, and tell them you want to appeal. Write down the date and time, and the name of the person you spoke to.

If you are appealing because your start date is wrong, or because you haven’t heard from TennCare in 45 days, you should also send in any proof that you have of the date that you applied on the Marketplace. If you don’t have this, that’s okay; you should appeal anyway!

Services Appeal

File a service appeal if you are on TennCare, but you can’t get something you need. Do you need a medical service or medicine that t? Do you have medical bills you think TennCare should pay for? Do you want to change your health plan (MCO)?  Did TennCare authorize less treatment than you need? You should appeal if you need something you can’t get.

You can appeal by:

  • Sending in this appeal form to TennCare solutions.
    • You can fax it to 1-888-345-5575. Keep the fax receipt.
    • Or, you can mail it to: TennCare Solutions, P.O. Box 593, Nashville, TN 37202-0593.
  • Calling TennCare Solutions at 1-800-878-3192. Write down the date and time, and the name of the person you spoke to.

When you appeal, be sure to tell TennCare what care you need and the name of the doctor that ordered it. You can visit the TennCare website for more information on how to file a medical appeal.