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Get Filing A Complaint Against Tenncare Provider

Am Please complete this form and fax or mail it back to us. You will be copied on our correspondence concerning this matter. Please provide documentation that supports your complaint. DO NOT send any Member Protected Health Information (PHI) via email unless you have HIPAA compliant encrypted email. PHI includes the members name and other demographic information. Complainant Information Provider Representative Prefix: Mr. Mrs. * Required field Ms. Dr. First Name*: Last Name*: Provider Na.

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