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Get Tennessee Private Icfidd Providers Form

Rticipation in TennCare. Pursuant to CFR Title 42, Chapter 455.460, a registration fee of $523.00 (Five hundred and twenty-three dollars) will be assessed. This fee must be paid by check or money order only. In accordance with Chapter 0620-1-10 of the Rules and Regulations of the State of Tennessee, a returned check fee of $20.00 will be assessed for all checks returned due to insufficient funds. See below for a list of the items necessary to complete your packet. This page should be completed a.

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