Tennessee Pharmacists Association

MTM in Medicaid

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If you are interested in participating in the MTM in Medicaid Pilot Program, please email MTMpilot@localhost.  TennCare will determine pharmacists’ eligibility based on numerous factors, including provider location and completion of the required steps listed below.

On January 1, 2020, TennCare took action to update the reimbursement methodology for pharmacists providing MTM in Medicaid through the Pilot Program that began on January 1, 2018. Case rates have now increased to $55 and $75, depending on case risk assessment. While requirements have remained the same, TennCare has taken steps to remove barriers in documentation and access to care and have even re-sequenced training for the Care Coordination Tool (CCT).

Information about the MTM in Medicaid Pilot Program and its recent changes can be found below.

GENERAL INFORMATION

REQUIREMENTS FOR PARTICIPATIONPharmacists must meet the following criteria to qualify as TennCare MTM pharmacists.


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STEP 1:  Get an NPI

The pharmacist must have a valid Tennessee license and NPI number and must meet the minimum insurance requirements (i.e., professional liability). Pharmacists should obtain an individual pharmacist provider NPI by clicking HERE.


STEP 2:  Get a TennCare Provider ID

The participating pharmacist must acquire his or her own TennCare Medicaid ID. Information on provider registration and how to access the provider portal can be found on the TennCare Provider Registration website.

a. For more information concerning provider registration, please email Provider.Registration@tn.gov or call 1-800-852-2683, option 5.

STEP 3:  Collaborate with PCMHs and HealthLink Organizations

The MTM pharmacist must have a written formal Collaborative Practice Agreement (CPA) in place with a TennCare Patient-Centered Medical Home (PCMH) or Tennessee HealthLink (THL) organization.

a. The CPA establishes pharmacists to prescribing provider (supervising physician) expectations from scope of practice to documentation. See Section 17 in the Tennessee Board of Pharmacy rules.
b. CPA guidance and minimum requirements
c. Additional information about CPA requirements (on the TPA website)
d. Access the list of TennCare PCMH organizations and THL organizations

STEP 4: Complete the CAQH Process

Individual providers will submit information that will place him or her on the Council for Affordable Quality Healthcare (CAQH) roster for TennCare/Tennessee Medicaid. Information and links, including an FAQ document, can be found HERE. Once data is received from CAQH and approved, a Medicaid ID will be assigned. It is also important to note that TennCare will automatically receive the provider’s profile data from CAQH each time the provider makes an update.

a. Click here to log in and complete the CAQH process.

STEP 5:  Enroll in MTM Provider Networks

The MTM pharmacist must engage and complete the Managed Care Organizations (MCOs) credentialing and network agreements. Register on the CAQH EnrollHub for the networks listed below. The pharmacist will need to contact the three TennCare MCOs listed below and specifically request to be enrolled as a medical provider for the TennCare MTM in Medicaid Pilot Program. The provider manuals for the three TennCare MCOs administering the Pilot Program are linked below:

a. Amerigroup Network Access
b. United Healthcare Network Access
c. BlueCare Network Access

For specific health plan questions, the contact information for each MCO can be found HERE.


STEP 6:  Authorize the Care Coordination Tool (CCT)

The MTM pharmacist participating in the MTM pilot program must document in the CCT and must complete the onboarding registration, training and access process for the CCT. After a CPA is in place, the pharmacist may initiate CCT registration by emailing the following information to TennCare.Pharmacy.AdobeSign@tn.gov.

a. NPI
b. TennCare/Medicaid ID
c. Name of TennCare PCMH or THL Organization
d. Name(s) of pharmacist(s)
e. Email address (contact information)
f. Copy of CPA attestation/addendum signed by supervising physician and pharmacist providing services
(CCT access will be granted after the MCO credentialing and network processes are completed.)
g. The CCT tool enables providers to see real-time information about members in need of follow-ups, which will allow providers to help close gaps in care. At this time, those manual gaps in care closures will not contribute to the quality performance reported from the MCOs each quarter, unless a corresponding claim is received to verify the gap has been closed.

STEP 7: Agree to TennCare Privacy Policies

Each user will be required to sign TennCare’s Acceptable Use Policy and Remote Access Request forms to ensure that health information is protected.


STEP 8: Provide MTM Services and Submit Claims

ALL registration steps listed above must be completed prior to providing MTM services and submitting claims for reimbursement. After completion, MTM services may be provided to patients, and claims may be submitted.