Medical Billing Services in Tennessee
As a remote-first medical billing company serving Tennessee practices statewide, MedPrecision pairs TN-specific payer expertise with AAPC-certified billing experts. BlueCross BlueShield of Tennessee anchors Tennessee's commercial payer mix, and any practice that mishandles its fee schedule, modifier rules, or appeal deadlines bleeds revenue every quarter. The clock that catches Tennessee practices out is TennCare's: a claim to a TennCare managed care organization must be filed within 120 calendar days of the date of service, not the year that TennCare's own fee-for-service claims get (TennCare Policy Manual, PAY 13-001 (Rev. 2), Timely Filing, read 17 September 2026). On the commercial side, Tennessee Code Annotated 56-7-109 sets the prompt-pay clock at 21 calendar days for a clean claim filed electronically and 30 days for a clean paper claim, which gives providers a real lever when a payer stalls on a clean submission. We run Tennessee claim queues with payer-segmented edits, portal automation for the TennCare plans and BlueCross BlueShield of Tennessee, and appeal letters drafted against the rule that actually governs that payer.
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The Tennessee Billing Landscape
TennCare has run Tennessee's Medicaid program as statewide managed care since the 1990s, and the Division of TennCare now contracts with three managed care organizations — BlueCare Tennessee, Wellpoint (formerly branded Amerigroup) and UnitedHealthcare Community Plan — plus TennCare Select for specific populations. Tennessee has not adopted the ACA Medicaid expansion, which leaves a coverage gap that reaches practices as self-pay balances. The commercial market is led by BlueCross BlueShield of Tennessee, Cigna, UnitedHealthcare and Aetna. Nashville is a national center of for-profit hospital management, and that concentration shapes how hard local fee schedules get negotiated. The billing detail that costs Tennessee practices real money is the filing clock: a claim to a TennCare plan has 120 calendar days from the date of service, while TennCare's own fee-for-service claims have a year, so a practice that manages every Medicaid claim on a one-year assumption writes off managed care claims it could have collected. School-based therapy claims billed to a TennCare plan under an IEP are the exception the policy names, at one year. On the payment side, Tennessee Code Annotated 56-7-109 gives commercial payers 21 calendar days on a clean electronic claim and 30 on paper. Memphis carries a high Medicaid population and significant health disparities, while East Tennessee's market is shaped by Covenant Health and Ballad Health. The state's geography creates distinct billing environments from urban Nashville and Memphis to rural Appalachian communities, and the telehealth coverage rules in Title 56, Chapter 7, Part 10 reach both the commercial plans and the TennCare plans.
Who We Serve in Tennessee
Our Tennessee client mix skews toward solo practices, group practices, pediatric practices , plus family practice groups and telehealth providers. We work with providers in Nashville, Memphis, Knoxville and across the rest of the state, all remotely.
Major Metros Served
What billing costs in Tennessee
We publish one national rate card and bill Tennessee practices on exactly the same terms as everywhere else — there is no regional markup and no quote-only tier below enterprise. You pay a percentage of what we actually collect, so if we do not collect, you do not pay.
| Practice size | Rate | Basis | Note |
|---|---|---|---|
| Solo practice | 7.0% | of monthly collections | Monthly minimum applies |
| Group practice | 6.0% | of monthly collections | Volume discounts available |
| Enterprise | Custom | tiered pricing | Scoped per engagement |
- No setup or implementation fee
- No per-claim charge
- No software fee and no markup on third-party costs — clearinghouse fees, postage and payer application fees are passed through at cost
- 12-month initial term, then month-to-month — 60 days' notice either way, no early-termination penalty
Payer Landscape in Tennessee
TennCare (Tennessee Medicaid managed care) routes members through BlueCare Tennessee, Wellpoint (formerly Amerigroup), UnitedHealthcare Community Plan and 1 more plans, each with its own authorization rules and fee schedule. On the commercial side, BlueCross BlueShield of Tennessee, UnitedHealthcare, Aetna drive the bulk of Tennessee claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in Tennessee run 120 days for Medicaid and 90-180 days for commercial payers — deadlines our A/R queues are built around. Tennessee's prompt-pay statute: Tennessee Code Annotated 56-7-109 requires a health insurance entity to pay a clean claim within 21 calendar days when it is filed electronically and within 30 calendar days when it is filed on paper. TennCare plans answer to a separate standard, Tennessee Code Annotated 56-32-126(b)(1): 90 percent of claims that need no further information paid within 30 calendar days, and 99.5 percent of all provider claims processed within 60 calendar days. Verified against Tennessee Department of Commerce and Insurance examination and complaint documents published at tn.gov on 17 September 2026.
Medicaid Program
TennCare (Tennessee Medicaid managed care)
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
Tennessee Code Annotated 56-7-109 requires a health insurance entity to pay a clean claim within 21 calendar days when it is filed electronically and within 30 calendar days when it is filed on paper. TennCare plans answer to a separate standard, Tennessee Code Annotated 56-32-126(b)(1): 90 percent of claims that need no further information paid within 30 calendar days, and 99.5 percent of all provider claims processed within 60 calendar days. Verified against Tennessee Department of Commerce and Insurance examination and complaint documents published at tn.gov on 17 September 2026.
Tennessee Billing Regulations & Compliance
The Tennessee Department of Commerce and Insurance sets the rules our Tennessee billing workflows have to satisfy. Surprise billing in Tennessee: Federal No Surprises Act applies. Tennessee has limited additional state-level surprise billing protections. Telehealth parity: Tennessee Code Annotated Title 56, Chapter 7, Part 10 requires a health insurance entity — a definition that includes the TennCare managed care organizations — to cover and reimburse telehealth and provider-based telemedicine encounters consistently with what the policy provides for the same service in person, without regard to where the patient is located. It does not require paying more than the in-person amount, it does not reach plans governed by ERISA, and provider-based telemedicine as defined excludes audio-only conversations, email, text and fax, so audio-only coverage is a payer-by-payer question. Verified against the bill text published by the Tennessee General Assembly on 17 September 2026.
State Insurance Regulator
Tennessee Department of Commerce and Insurance
Surprise Billing Protection
Federal No Surprises Act applies. Tennessee has limited additional state-level surprise billing protections.
Telehealth Billing Parity
Tennessee Code Annotated Title 56, Chapter 7, Part 10 requires a health insurance entity — a definition that includes the TennCare managed care organizations — to cover and reimburse telehealth and provider-based telemedicine encounters consistently with what the policy provides for the same service in person, without regard to where the patient is located. It does not require paying more than the in-person amount, it does not reach plans governed by ERISA, and provider-based telemedicine as defined excludes audio-only conversations, email, text and fax, so audio-only coverage is a payer-by-payer question. Verified against the bill text published by the Tennessee General Assembly on 17 September 2026.
Common Questions
Common questions about medical billing services in Tennessee.
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Get a Free Billing AuditHow does MedPrecision handle TennCare MCO billing?
TennCare is delivered through three statewide managed care organizations — BlueCare Tennessee, Wellpoint (the plan formerly branded Amerigroup) and UnitedHealthcare Community Plan — plus TennCare Select for specific populations, as listed by the Division of TennCare on 17 September 2026. Each has its own authorization rules, portal and claim address, and all of them run on a 120-calendar-day filing limit rather than the one year TennCare allows on its own fee-for-service claims. We hold your TennCare work to the 120-day clock and to the exceptions that move it: with retroactive eligibility the clock starts when TennCare notifies the plan of the enrollment, and in a third-party liability case it starts when the other carrier documents resolution of the claim.
How does Nashville's healthcare market affect billing for local practices?
Nashville is home to major healthcare corporations including HCA Healthcare, Community Health Systems, and numerous specialty groups, creating a competitive market with sophisticated payer negotiations. Our team understands the Nashville market dynamics, including the influence of large health systems on fee schedules and the commercial payer landscape that local practices must navigate.
What are Tennessee's prompt pay requirements?
Two different clocks apply in Tennessee, and the page you are reading used to state only one of them. For commercial insurance, Tennessee Code Annotated 56-7-109 gives the payer 21 calendar days to pay a clean claim filed electronically and 30 calendar days for a clean paper claim — the same figures the Tennessee Department of Commerce and Insurance applies in its market-conduct examinations and prompt-pay complaint guidance. TennCare plans answer to a separate standard in Tennessee Code Annotated 56-32-126(b)(1): 90 percent of claims that need no further information paid within 30 calendar days, and 99.5 percent of all provider claims processed within 60 calendar days. We track each claim against the clock that actually governs it instead of applying one deadline to every payer.
Does MedPrecision support pediatric billing in Tennessee?
Yes. Tennessee has a strong pediatric care focus, and our billers are experienced with well-child visit coding, vaccine administration billing, developmental screening codes, and TennCare's pediatric-specific coverage rules. We help pediatric practices capture full reimbursement for every visit while staying compliant with TennCare guidelines.
What happens if a payer misses the Tennessee prompt-pay deadline?
For commercial coverage the deadline is in Tennessee Code Annotated 56-7-109 — 21 calendar days on a clean electronic claim, 30 on a clean paper claim — and the Tennessee Department of Commerce and Insurance accepts provider prompt-pay complaints when a payer misses it. TennCare plans are measured differently, under Tennessee Code Annotated 56-32-126(b)(1): 90 percent of claims requiring no further information paid within 30 calendar days and 99.5 percent of all provider claims processed within 60 calendar days, which is the standard the Department quotes in its examination reports. We flag stalled payments in our A/R reports against whichever clock applies, escalate to the plan first, and file with the Department when the plan will not move. Filing deadlines are a separate matter: TennCare managed care claims must be filed within 120 calendar days of the date of service, TennCare fee-for-service claims within one year, and commercial claims typically within 90-180 days. Verified against the TennCare Policy Manual (PAY 13-001, Rev. 2) and Tennessee Department of Commerce and Insurance publications on 17 September 2026.
How do I choose a medical billing company in Tennessee?
Prioritize a billing company that already works with TennCare and the major commercial payers in Tennessee — payer-specific edits and timely-filing windows are where most TN revenue leaks start. Ask about AAPC-certified coders, transparent pricing, and denial-rate and days-in-A/R reporting before you sign. Because billing is delivered remotely, a company's Tennessee payer experience matters more than a local office address.
Services for Tennessee practices
Specialties we bill for
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Services in Tennessee
Specialties in Tennessee
Other Locations We Serve
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