Medical Billing Services in Tennessee

Tennessee runs one of the most structured Medicaid managed care systems in the country, and that structure is exactly what makes its billing unforgiving. Nearly every TennCare member sits in one of three managed care organizations, and each organization runs its own contracts, fee schedules, claim edits, and authorization rules. A practice that bills TennCare from a single generic workflow will see denials that have nothing to do with the care delivered and everything to do with the plan on the card.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Tennessee practices of every specialty, built around the state’s actual payers and programs.

Tennessee’s payer landscape

Tennessee Medicaid is called TennCare, delivered through three managed care organizations: BlueCare Tennessee, UnitedHealthcare Community Plan of Tennessee, and Wellpoint Tennessee (formerly Amerigroup). A fourth plan, TennCare Select, covers defined special populations. Each MCO maintains its own contracts, fee schedules, claims processing, and provider network, so enrollment with the state alone does not put a practice in every plan’s network. Credentialing and contracting must be completed with each MCO a practice wants to bill.
Commercial coverage is led by BlueCross BlueShield of Tennessee, alongside Cigna, UnitedHealthcare, Humana, and Aetna. Medicare and Medicare Advantage plans add their own prior authorization rules on top of the TennCare and commercial mix.

What MedPlus RCM handles for Tennessee practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with TennCare MCOs, commercial payers, and Medicare, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
    We serve practices statewide, Nashville, Memphis, Knoxville, Chattanooga, Clarksville, and Murfreesboro, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.

Results Tennessee practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Why is TennCare billing complicated?
Each TennCare MCO runs its own contracts, fee schedules, and authorization rules. A claim built for one MCO’s edits can deny under another’s, so MCO assignment must be verified and the claim built to that plan’s rules.
Do you work with TennCare MCOs?
Yes. We bill BlueCare Tennessee, UnitedHealthcare Community Plan of Tennessee, and Wellpoint Tennessee, plus TennCare Select where applicable, as well as commercial and Medicare plans.
Does state TennCare enrollment cover all MCOs?
No. State registration is only the first step. A practice must credential and contract separately with each MCO it wants to bill, or claims deny for lack of plan participation.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your Tennessee practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
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