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Tennessee - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Division of TennCare funds Durable Medical Equipment (DME) and disposable medical supplies for waiver participants primarily through the TennCare CHOICES and Employment and Community First (ECF) CHOICES managed long-term services and supports (MLTSS) programs. Providers must secure active network contracts with at least one of the three state-contracted Managed Care Organizations (MCOs)—Wellpoint, UnitedHealthcare Community Plan, or BlueCare Tennessee—before they can receive authorizations or bill for waiver-funded supplies.

Approval requires registering through the TennCare Provider Registration portal to obtain a Medicaid ID, but this registration alone does not grant access to waiver participants. Applicants must pass MCO credentialing, which mandates a Type 2 National Provider Identifier (NPI) and adherence to TennCare Division rules for medically necessary equipment limits.

1. Service Definition and Scope

Under TennCare rules (Chapter 1200-13-13), Durable Medical Equipment (DME) is defined as equipment that can stand repeated use, serves a medical purpose, is appropriate for home use, and is related to the member's physical disorder. Disposable medical supplies are covered based on medical necessity and specific TennCare Division regulations.

The service ensures waiver participants receive the most basic equipment that will provide the needed care, as authorized in their Person-Centered Support Plan (PCSP).

2. Regulatory and Oversight Agencies

The Division of TennCare oversees the Medicaid program and sets the overarching rules for DME and medical supplies. Day-to-day administration, prior authorization, and provider oversight are delegated to the contracted MCOs.

Providers must interact with both the state portal for baseline enrollment and the MCO portals for operational compliance.

3. Gatekeeping Prerequisites: Who Can Even Apply

Tennessee utilizes a managed care model for its HCBS waivers. The absolute prerequisite for serving CHOICES members is securing a network contract with a TennCare MCO.

Without an MCO contract, a provider cannot receive authorizations or reimbursement, regardless of their active status in the state's Medicaid portal.

4. Licensure and Certification Requirements

Tennessee does not issue a distinct "HCBS Medical Supply" license. Providers must meet general state requirements for medical equipment suppliers and MCO credentialing standards.

If the provider supplies respiratory or life-support equipment, they must hold a Home Medical Equipment Provider license from the Tennessee Department of Health.

5. Medicaid Provider Enrollment

All new and existing providers must register via the web-based TennCare Provider Registration system. This generates the TennCare/Medicaid ID required for MCO contracting.

The state strictly enforces ownership disclosure rules during this step to prevent fraud and abuse.

6. Staffing, Training and Background Checks

While DME providers do not provide direct hands-on personal care, staff delivering or fitting equipment must meet basic safety and background requirements as stipulated by MCO contracts.

Agencies must ensure that any employee entering a member's home is cleared through state and federal registries.

7. Documentation, Policies and Records

Providers must maintain complete and orderly medical records for at least 10 years from the close of the Tennessee Program Agreement.

Documentation must clearly link the delivered supplies to the authorizations generated by the member's PCSP.

8. Billing, Rates and Claims

Claims are submitted directly to the member's MCO, not to the state. Prior authorization is required for all CHOICES services.

Providers must also submit Medicare/Medicaid "cross-over" claims to TennCare for consideration of Medicare copays and deductibles for members with Medicare as a primary carrier.

9. Approval Sequence and Timeline

The process begins with obtaining an NPI and registering with TennCare, followed by the lengthy MCO credentialing and contracting phase.

Providers should expect the entire process to take several months, primarily due to MCO network adequacy reviews.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to missing ownership disclosures or lack of prior authorization.

MCOs may also deny network entry if they determine their current DME network is adequate for a specific region.

11. Key Contacts and Resources

Primary support is handled through the TennCare Provider Services call center and the respective MCO provider relations departments.

Providers must maintain active communication with the MCOs for authorization and billing issues.

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