(a) Health insurance entities, as defined in § 56-7-109, that contract with the state and perform services for the TennCare program or any successor program pursuant to title 71 shall establish reasonable protocols and procedures for reimbursing physicians employed by federally qualified health centers, so long as the protocols and procedures do not violate National Committee for Quality Assurance (NCQA) standards. At a minimum, the protocols and procedures shall:

lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Tennessee Code 56-7-1014

  • Contract: A legal written agreement that becomes binding when signed.
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
(1) Subject to approval of a physician credentialing application, permit physician reimbursement for rendered services from the date the physician’s completed credentialing application is received for consideration by the health insurance entity; provided, however, that a contractual relationship exists between the provider or the group or facility for whom the physician works; and
(2) Require that any reimbursement paid the physician shall be retroactively recouped or rescinded in the event the physician’s credentialing application is denied.
(b) As an alternative to subsection (a), health insurance entities, as defined in § 56-7-109, that contract with the state and perform services for the TennCare program or any successor program pursuant to title 71 may establish an expedited credentialing process for reimbursing physicians employed by federally qualified health centers, so long as the process does not violate NCQA standards.
(c) As used in this section, “federally qualified health center” means entities defined in §§ 1861(aa) and 1905 of the federal Social Security Act (42 U.S.C. § 1395x and 42 U.S.C. § 1396d, respectively).
(d) Nothing in this section shall require reimbursement of physician-rendered services that are not benefits or services covered by the health insurance entity.
  Previous section
Next section  
 Part 10 Contents