Get the free TennCare Dental Provider Appeal Form

Tenner Dental Provider Appeal Form Member name: ___ Member ID number: ___ Date of service: ___ Date EOB received: ___ Authorization number: ___ Date authorization was received: ___ Provider Name:

How to fill out tenncare dental provider appeal

How to fill out tenncare dental provider appeal

1. Contact TennCare to request a Dental Provider Appeal form.
2. Fill out the form completely and accurately, providing all necessary information and supporting documentation.
3. Submit the completed form to TennCare within the specified time frame, typically within 30 days of the denial or adverse action.
4. Wait for TennCare to review your appeal request and make a decision.
5. If your appeal is approved, follow any instructions provided by TennCare for next steps.
6. If your appeal is denied, you may have the option to request a fair hearing to further review the decision.

Who needs tenncare dental provider appeal?

1. Dental providers who have had a claim denied by TennCare and believe that the denial was made in error.
2. Dental providers who have received an adverse action from TennCare and wish to challenge it.

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