Tennessee Billing Reference

Medical Billing in Tennessee: TennCare, Payer Landscape & Timely Filing

The working reference for Tennessee billing teams: who the payers are, how TennCare managed care is structured, and the filing windows that govern your claims. Updated July 2026.

Get the 2026 Benchmark Report → Denial Management Guide

Medical Billing in Tennessee: The Short Version

Tennessee's TennCare is one of the strictest Medicaid programs in the country — 120-day timely filing, fully managed care, and no Medicaid expansion creates a difficult billing environment. BlueCross BlueShield of Tennessee (BCBST) holds a unique dual role: it is both the dominant commercial insurer statewide and the administrator of BlueCare, TennCare's largest MCO. A critical operational trap for billing teams is submitting TennCare BlueCare claims through commercial BCBST workflows — they use different payer IDs, fee schedules, and portals. UnitedHealthcare exited TennCare effective January 1, 2026; those members have been reassigned to BlueCare or Wellpoint.

Payer Landscape

Major Payers in Tennessee

Payer	Type	What Billing Teams Should Know
BlueCross BlueShield of Tennessee (BCBST)	Commercial / Blues Plan / MA	Dominant commercial insurer statewide. Also administers BlueCare (TennCare MCO) — separate payer IDs, fee schedules, and portals for each; never mix claims
UnitedHealthcare	Commercial / MA	UHC exited TennCare MCO December 31, 2025 — remains active as commercial and Medicare Advantage carrier. Verify patient coverage type at every visit
Cigna / Evernorth	Commercial PPO/HMO	Significant employer-sponsored presence in Nashville, Memphis, and Knoxville metro areas. Standard 90-day in-network timely filing
Aetna (CVS Health)	Commercial PPO/HMO / MA	Active commercial and Medicare Advantage presence. State marketplace and large employer groups. 90-day in-network timely filing standard
Humana	Medicare Advantage	Exited employer commercial medical market in 2024. Now active primarily as Medicare Advantage carrier in Tennessee — MA requires separate billing workflow
TennCare (Bureau of TennCare)	Medicaid (via MCOs)	120-day timely filing from date of service; two MCOs (BlueCare, Wellpoint) plus TennCare Select PIHP. Bill the patient's MCO — never the state directly for managed care

Medicaid Structure

TennCare: Managed Care Plans (2026)

Administered by the Bureau of TennCare, Tennessee Department of Finance and Administration. UnitedHealthcare exited December 31, 2025 — TennCare now operates with two standard MCOs plus TennCare Select. The patient's MCO assignment determines the portal, prior-auth list, and the 120-day filing clock.

Plan	Notes
BlueCare Tennessee	Administered by BCBST. Largest TennCare MCO by enrollment. Serves adults and children statewide across all TennCare populations
Wellpoint Tennessee	Formerly Amerigroup Tennessee (rebranded). Subsidiary of Elevance Health. Statewide coverage for standard TennCare populations
TennCare Select	Prepaid Inpatient Health Plan (PIHP) administered by BCBST. Serves children in foster care, SSI recipients, and members in institutional settings. Acts as statewide backup plan

Filing Deadlines

Timely Filing Limits for Tennessee Claims

TennCare's 120-day window is among the shortest Medicaid timely filing limits in the country. Commercial limits are contract-specific — always confirm against your provider agreement and the payer's current manual.

Payer	Timely Filing Limit	Notes
TennCare (All MCOs)	120 days from date of service	TennCare Policy PAY 13-001. Applies to BlueCare and Wellpoint. Clock starts at date of service, not discharge
Medicare (Original)	12 months from date of service	Set by federal law (42 CFR §424.44); no contract variation
UnitedHealthcare (Commercial)	90 days from date of service	Standard commercial; some contracts extend to 180 days. Verify your specific provider agreement
Aetna (Commercial)	90 days in-network; 12 months out-of-network	In-network contracted providers: 90 days. Verify current contract
Cigna (Commercial)	90 days in-network; 180 days out-of-network	COB claims: 90 days from primary EOB. Verify provider agreement
Humana (Medicare Advantage)	365 days from date of service	Applies to Medicare Advantage plans. Humana exited employer group commercial market in 2024
BlueCross BlueShield of Tennessee (Commercial)	90–180 days (plan-dependent)	Typically 180 days for in-network commercial. BlueCare TennCare: 120 days. Verify by contract

Verified against payer publications (July 2026). Filing limits change by contract and plan year — treat this table as a starting point, not a substitute for the payer manual.

TN-Specific Rules

Tennessee Billing Realities to Know

TennCare 120-Day Hard Deadline

Unlike states that allow 365 days, TennCare mandates 120 days from the date of service — not the date of discharge. Billing teams must flag any claim approaching the 90-day mark. Appeals for late claims require documented good cause; retroactive eligibility situations are the most common legitimate exception.

UHC TennCare Exited January 2026

UnitedHealthcare's TennCare MCO contract ended December 31, 2025. Former UHC TennCare members were reassigned to BlueCare or Wellpoint. Outstanding 2025 DOS claims still route to UHC TennCare during runout. New 2026 dates of service go to the member's new MCO — re-verify eligibility for every patient previously on UHC TennCare.

No Medicaid Expansion — Coverage Gap

Tennessee is one of the few states that has not adopted Medicaid expansion as of 2026. This creates a coverage gap of approximately 95,000 residents who are ineligible for TennCare but also ineligible for ACA subsidies. The statewide uninsured rate of ~9.3% is among the highest in the country — billing teams will encounter more uninsured self-pay patients than in expansion states.

BCBST Operates Both Commercial and TennCare

BlueCross BlueShield of Tennessee is both the dominant commercial insurer and the administrator of BlueCare (TennCare's largest MCO). These are entirely different rule sets, fee schedules, and portals. Never route BlueCare TennCare claims through commercial BCBST workflows — separate payer IDs and authorization pathways are required for each.

Frequently Asked Questions

TennCare enforces a 120-day timely filing window from the date of service — considerably shorter than many state Medicaid programs. This applies to all MCOs (BlueCare Tennessee and Wellpoint Tennessee). Claims received after 120 days will be denied unless a documented exception applies. Billing teams should flag any claim approaching 90 days for immediate action. The rule is set under TennCare Policy PAY 13-001.

TennCare BlueCare and commercial BCBST use different payer IDs and portals. BlueCare Tennessee Medicaid has its own payer ID for electronic claim submission via Availity or your clearinghouse. Commercial BCBST uses a separate payer ID. Always verify the patient's program (TennCare vs. commercial) before claim submission — TennCare MCO fee schedules and authorization requirements differ substantially from BCBST commercial contracts.

UnitedHealthcare's TennCare MCO contract ended December 31, 2025. Former UHC TennCare members were reassigned to either BlueCare Tennessee or Wellpoint Tennessee for 2026 coverage. Providers should re-verify insurance eligibility for all patients who were previously on UHC TennCare. Outstanding claims with DOS in 2025 are still processed through UHC TennCare. New DOS January 1, 2026 and forward will route to the member's new MCO.

Yes. Tennessee enacted state balance billing protections (T.C.A. 56-7-120) that restrict out-of-network providers from balance billing patients for emergency services and inadvertent out-of-network encounters at in-network facilities, supplementing the federal No Surprises Act effective January 1, 2022. For billing disputes, providers use the federal Independent Dispute Resolution (IDR) arbitration process.