Get Filing A Complaint Against Tenncare Provider

Filing a complaint against a TennCare provider can be an important step in addressing issues you may have encountered with their services. This guide provides you with clear, step-by-step instructions to effectively complete the Filing A Complaint Against Tenncare Provider form online, ensuring that your concerns are properly documented and addressed.

Follow the steps to successfully submit your complaint online.

1. To begin, click the ‘Get Form’ button to download the Filing A Complaint Against Tenncare Provider form and open it in your document editor.
2. Fill out the complainant information section, which includes providing your prefix, first name, and last name. Ensure all required fields are marked with an asterisk (*) are completed.
3. Enter your contact details, including your street address, city, state, zip code, phone number, fax number, and email address. These details help TennCare to correspond with you regarding your complaint.
4. In the TennCare plan information section, select the appropriate plan name from the list provided. This helps identify the correct network involved in your complaint.
5. Specify the type of service related to your complaint, such as physical health, pharmacy, or dental services. Check all that apply.
6. Input the start and end dates for the services you are complaining about. These dates help establish the time frame for your grievance.
7. In the reasons for your complaint section, check all relevant issues such as claim denials, payment delays, or medical necessity concerns. Be honest and thorough.
8. Provide a detailed written description of the problem. If your explanation requires more space, feel free to attach additional pages with your documentation.
9. If your complaint involves multiple members, prepare and attach an electronic Excel spreadsheet as instructed, making sure to follow all guidelines around the information required.
10. Finally, state what resolution you seek from the TennCare MCC or the TennCare Bureau. This clarifies what you hope to achieve with your complaint.
11. If you are not the aggrieved provider, provide your relationship to the provider. Then, declare that the information you have provided is accurate by signing and dating the form.
12. After completing the form, save your changes and ensure that you have all required attachments. You can then print the form or share it as necessary before faxing or mailing it to the appropriate TennCare Office.

Start the process of filing your complaint against a TennCare provider online today.