Statewide Healthcare RCM Coverage • 501 Cities & Towns
Medical Billing & RCM Services in Tennessee
Delivering tailored medical coding, billing, and credentialing services across Tennessee. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Tennessee Medicare MAC Jurisdiction & Payer Regulations (J-J)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Tennessee medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-J
Jurisdiction J (J-J)
Contractor:
Palmetto GBA, LLC (HQ: Columbia, SC)
State Medicaid & Public Health Agency
TN
Tennessee Division of TennCare (TennCare)
Governing Agency:
Tennessee Division of TennCare
Medicaid Timely Filing:
365 days from Date of Service / 120 days from Medicare RA
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Tennessee (J-J):
4 Active LCDs
L38397
MolDX: Molecular Diagnostic Services
L36593
Polysomnography and Sleep Testing
L34547
Non-Vascular Ultrasound
L37643
Debridement Services
Regional Billing Nuances & Compliance Safeguards:
MolDX Regulatory Authority: Palmetto GBA establishes national MolDX policies mirrored across MACs. All precision medicine labs must submit assays through the DEX registry.
Georgia GAMMIS & Tennessee TennCare: Secondary balance coordination across TennCare MCOs (BlueCare, Wellpoint, UHC Community Plan).
Polysomnography requires documented Epworth Sleepiness Scale score >= 10 and AHI/RDI >= 15.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Healthcare Locations & Cities in Tennessee
Select your city below for specialized local medical billing solutions and regional payer expertise.