§ 56-32-132. Investigatory Powers of the Department of Commerce and Insurance
For the purposes of regulation and oversight of HMOs that participate in the TennCare program under Title XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, and in addition to the powers and duties set forth in this title, the department of commerce and […]
§ 56-32-134. Required Information for Verification and Audit Purposes
As used in this section, “affiliate” has the same meaning as defined in § 56-32-102. For verification and audit purposes, each managed care organization that participates in the TennCare program shall provide to the department of commerce and insurance the following information for its organization: The names and addresses of all persons required to file […]
§ 56-32-135. Confidentiality
Any information and documentation obtained by the department pursuant to § 56-32-117(c) or § 56-32-132, shall be considered confidential, unless the commissioner in the commissioner’s sole discretion determines to disclose the information or documentation.
§ 56-32-136. Violation and Penalty
A violation of this chapter shall subject the violator to the penalty contained in § 56-1-801.
§ 56-32-137. Discrimination Prohibited — Coverage Not Created
A managed health insurance issuer shall not discriminate with respect to participation, referral, reimbursement of covered services, or indemnification as to any provider who is acting within the scope of the provider’s license or certification under state law, solely on the basis of the license or certification. In selecting among providers of health services for […]
§ 56-32-138. Payment of Authorized Pharmacy Claims — Corrections by Pharmacy
If authorization is given and a pharmacy claim is adjudicated by an HMO or its agent to any pharmacy services provider for care to be delivered to a covered beneficiary under any evidence of coverage issued by the HMO, including those organizations participating in the TennCare program, collectively referred to as “organization,” then the organization […]
§ 56-32-125. Confidentiality of Information
Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from the person or from any provider by any HMO shall be held in confidence by the HMO and shall not be disclosed by the HMO to any person, except upon any one (1) of the following circumstances: […]
§ 56-32-126. Prompt Payment Requirements
HMOs shall be subject to the same requirements regarding prompt payment of claims, and the additional liability for bad faith failure to pay claims promptly, as are applicable to insurance companies under § 56-7-105. This subsection (b) is intended to ensure the prompt and accurate payment of all provider claims for services delivered to an […]
§ 56-32-128. Point of Service Option or Preferred Provider Organization Plan
As used in this section, “managed health insurance issuer” means an entity that: Offers health insurance coverage or benefits under a contract that restricts reimbursement for covered services to a defined network of providers; and Is regulated under this title or is an entity that accepts the financial risks associated with the provision of health […]
§ 56-32-129. Prohibited Discrimination
The managed health insurance issuer shall not discriminate with respect to participation, referral, reimbursement of covered services or indemnification as to any provider within a class of providers who is acting within the scope of the provider’s license or certification under state law, solely on the basis of the license or certification. In selecting among […]