A health insurance entity, as defined in § 56-7-109, regardless of status as a participating organization of the Council on Affordable Quality Healthcare (CAQH) or its successor, shall notify the health care provider of the results of the provider’s clean CAQH credentialing application and shall notify the health care provider as to whether or not […]
As used in this section: “Health insurance entity” has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5; “Healthcare services” has the same meaning as defined in § 56-61-102; “Healthcare services provider” means an individual acting within the scope of […]
As used in this section: “Health insurance entity” has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5; “Healthcare services” has the same meaning as defined in § 56-61-102; “Healthcare services provider” means an individual acting within the scope of […]
A managed health insurance issuer, as defined by § 56-32-128(a), that has contracted with a physician’s practice to be a part of that health insurance plan’s network of providers shall not directly contact or employ an agent to directly contact a patient of the physician’s practice in an effort to change a referral for services […]
Notwithstanding any other law to the contrary, a state mandated health benefit, as defined in § 3-2-111, that takes effect after March 24, 2016, shall apply not only to private health insurance issuers, as defined in § 3-2-111, but also any state or local insurance program, under title 8, chapter 27, and any managed care […]
As used in this section: “Continuing medical education” means board of medical examiners or board of osteopathic examination required continued postgraduate medical education intended to provide medical professionals with knowledge of new developments in the professional’s field; “Maintenance of certification” means any process requiring periodic recertification examinations or other activities to maintain specialty medical board […]
Whenever the commissioner performs a market conduct examination of a health insurance carrier that issues a health benefit plan under the jurisdiction of the department of commerce and insurance for compliance with § 56-7-2360, the examination shall include, but not be limited to, the following information: A description of the process used to develop or […]
The commissioner has the discretion to prescribe by regulation, after due consultation with providers of health care or treatment, accident and sickness insurers, hospital, medical and dental service corporations and other prepayment organizations representative of those organizations, claim forms for reporting by health care providers. The prescribed forms shall include, but need not be limited […]
A health insurance entity, as defined in § 56-7-109, that credentials or recredentials the providers in its networks shall accept, in addition to its own credentialing and recredentialing applications, the credentialing and recredentialing applications from the Council on Affordable Quality Healthcare (CAQH). If the health insurance entity is a participating organization of CAQH, then the […]
Notwithstanding any other law, and except as provided in this title, any person or other entity that provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether the coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject […]
As used in this section, “remote patient monitoring services” means using digital technologies to collect medical and other forms of health data from a patient and then electronically transmitting that information securely to healthcare providers in a different location for interpretation and recommendation. A health insurance entity may consider any remote patient monitoring service a […]
“Fee schedule” means a list of reimbursement amounts assigned to specific codes and used by a health insurance carrier pursuant to a contract between a health insurance carrier and a healthcare provider to calculate payments paid to the provider for therapies, procedures, materials, and other services delivered to enrollees. As used in this section, “health […]
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 […]
No patient, insurer, or third party payor shall be required to reimburse any licensed practitioner for charges or claims submitted in violation of this part. A clinical laboratory or physician, located in this state, or in another state, providing anatomic pathology services for patients in this state, shall present or cause to be presented a […]
This section shall be known and may be cited as the “Tennessee Health Freedom Act.” As used in this section: “Healthcare services” means any service, treatment, or provision of product for the care of physical or mental disease, illness, injury, defect or condition, or to otherwise maintain or improve physical or mental health, subject to […]
As used in this section: “Covered services” means dental care for which a reimbursement is available under the enrollee’s plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefits payments, or any other […]
