Medical Billing & Credentialing Services | Prohealthcare Advisors
- 410 Peachtree Pkwy, Suite 4245 Cumming, GA 30041
- Email: info@prohealthcareadvisors.com
- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
Medical Billing Credentialing Tennessee
Built for the Only State Where Every Medicaid Recipient Is in Managed Care
Tennessee is the only state in the country that requires 100% of TennCare recipients to enroll in managed care — no fee-for-service fallback exists. That means every Medicaid claim in your practice runs through one of just three MCOs, and getting the plan-specific rules wrong costs revenue on every visit, not just some.
Tennessee's Concentrated Medicaid Market
The 3 TennCare Managed Care Organizations
MCO
BlueCare Tennessee
Operated by BlueCross BlueShield of Tennessee — the largest TennCare MCO by enrollment.
MCO
UnitedHealthcare Community Plan
Tennessee's UnitedHealthcare Medicaid managed care plan under the TennCare program.
MCO
Wellpoint Tennessee
Formerly known as Amerigroup — rebranded under Wellpoint, still the same TennCare contract.
Tennessee Payer Coverage
We Bill & Credential With Tennessee's Full Payer Mix
| Payer | Plan Type | Tennessee Role | Status |
|---|---|---|---|
| TennCare | State Medicaid | 100% mandatory managed care — no FFS option | Full Service |
| Medicare — Palmetto GBA | Federal Medicare | MAC Jurisdiction J (AL, GA, TN) | Full Service |
| BlueCare Tennessee | Medicaid MCO | Largest TennCare managed care plan | Full Service |
| UnitedHealthcare Community Plan | Medicaid MCO | TennCare managed care plan | Full Service |
| Wellpoint Tennessee | Medicaid MCO | Formerly Amerigroup Tennessee | Full Service |
| BlueCross BlueShield of Tennessee | Commercial | Dominant commercial payer statewide | Full Service |
Why Tennessee Practices Choose Us
Palmetto GBA and TennCare Fluency, Nashville to Memphis
Common Questions
Medical Billing Credentialing Tennessee — FAQ
Is there a fee-for-service option for TennCare, or is managed care mandatory?
Tennessee is the only state that requires all Medicaid recipients to enroll in managed care — there is no fee-for-service fallback. Every TennCare claim runs through one of three contracted MCOs.
Do I need to credential separately with each TennCare MCO?
Yes — state enrollment with TennCare is the foundational step, but active credentialing with each applicable managed care organization is required before you can bill that plan. MCO credentialing won't begin until TennCare state enrollment is confirmed.
Who is Tennessee's Medicare Administrative Contractor?
Palmetto GBA administers Medicare Part A and B for Jurisdiction J, covering Alabama, Georgia, and Tennessee — the same jurisdiction as our home state.
What happens if I select the wrong TennCare enrollment category?
TennCare requires providers to select the correct enrollment category before submission — an incorrect selection triggers a denial. We verify the correct enrollment type before any application goes out.
Do you support both Nashville metro and rural Tennessee practices?
Yes — we handle Nashville's rapid-growth onboarding needs and rural East/West/Middle Tennessee practices with heavier TennCare and Medicare payer mixes, tuning our approach to each.
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Three MCOs, One Team That Knows Every Rule
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