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CLICK HERE  to access the “Medication Therapy Management” resources listed below — EXCLUSIVELY FOR TPA MEMBERS.

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The current TennCare MTM Operations Manual continues to list the following monthly case rates: $55 for Targeted Disease State (juvenile asthma and diabetes), Medium High, and Moderate cases; $75 for High and Critical cases. Limit Exception (U4) reimbursement is based on the applicable level-of-care modifier.

However, a significant program change occurred by March 2022, when all three TennCare MCOs transitioned management of the MTM program from TennCare. TennCare discontinued operating the MTM pilot directly and continued MTM as a mandatory directed MCO payment program. MTM providers continue to provide Comprehensive Medication Reviews, Targeted Medication Reviews, and General MTM Encounter services to eligible TennCare members.

Current TennCare guidance directs pharmacists to the applicable BlueCare, UnitedHealthcare Community Plan, or Wellpoint provider manual for current MTM reimbursement and billing information.

For links to details about the MTM in Medicaid information listed below, visit our members-only MTM in Medicaid page.

GENERAL INFORMATION

• Overview: TennCare’s MTM Program
• Infographic: Overview of Requirements for Participating in the MTM Pilot Program
• MTM Pharmacist Pilot: Reimbursement Guidelines
• Medication Therapy Management (MTM) Pilot Program Provider Operations Manual

REQUIREMENTS FOR PARTICIPATIONPharmacist(s) must meet the following criteria to qualify as a TennCare MTM pharmacist. Visit our members-only MTM in Medicaid page for the details.

• STEP 1:  Get an NPI
• STEP 2:  Get a TennCare Provider ID
• STEP 3:  Collaborate with PCMHs and HealthLink Organizations
• STEP 4:  Complete the CAQH Process
• STEP 5:  Enroll in MTM Provider Networks
• STEP 6:  Authorize the Coordination Care Tool (CCT) **Note: CCT not being used as of Sept. 2026 due to a data breach
• STEP 7:  Agree to TennCare Privacy Policies
• STEP 8:  Provide MTM Services and Submit Claims