Credentialing in Tennessee
Soft Home Global provides payer enrollment, revalidation and follow-up for Tennessee practices and billing companies at $2,150 per seat per month. Full time, worked during Tennessee business hours, inside your own system.
What is specific to Tennessee
TennCare enrols nearly its whole Medicaid population in managed care organizations, so eligibility, prior authorization and claims run through the member's health plan rather than a state fee-for-service desk.
Tennessee’s Medicaid programme is TennCare. Practices with a meaningful TennCare mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a credentialing seat does in Tennessee
Applications, revalidations and payer follow-up, with every enrollment's status visible.
TennCare is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during Tennessee business hours, not queued overnight
For the statute behind all of this — Tennessee’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Tennessee billing page.
TennCare, in practice
TennCare is delivered almost entirely through at-risk managed care, not fee-for-service, with three MCOs (Wellpoint — formerly Amerigroup, BlueCare, and UnitedHealthcare Community Plan) plus the separate non-risk TennCare Select plan for defined populations; verbatim: "Medical, behavioral and long-term care services are covered by 'at risk' Managed Care Organizations (MCOs) in each region of the state, and each participating MCO creates their own contracts with providers, maintains their own fee schedules, processes their own claims" and "All 3 Managed Care Organizations for TennCare have passed the NCQA (National Committee for Quality Assurance) accreditation process." Source
Working Tennessee hours
Tennessee runs on Central time, 11 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 8pm to 4am, and 7pm to 3am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
One wrinkle worth naming: the eastern third of the state runs on Eastern time. If your practice sits on that side of the line, say so on the call and the shift is set to your clock rather than the one most of the state keeps.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Tennessee hours and nobody else’s.
What it costs in Tennessee
$2,150
Per seat, per month, in US dollars — $25,800 a year for one full-time person, forty hours a week, on Tennessee hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Tennessee run $1,450 to $2,450; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Tennessee
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Tennessee practices?
Yes. Tennessee accounts are worked during Tennessee office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Tennessee?
TennCare enrols nearly its whole Medicaid population in managed care organizations, so eligibility, prior authorization and claims run through the member's health plan rather than a state fee-for-service desk.
How long do we have to file a TennCare claim?
1 year from the date of service, measured from the date of service. A resubmission or follow-up of a denied claim within 6 months of the date the original was filed. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: Tenn. Comp. R. & Regs. 1200-13-13-.08 — Providers.
When does a Tennessee payer have to pay a clean claim?
21 calendar days for electronically submitted claims; 30 calendar days for paper claims (Tenn. Code Ann. § 56-7-109) — within that window the health insurance entity must pay a clean claim or tell the provider in writing why it is not clean A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does credentialing cost in Tennessee?
$2,150 per seat per month — $25,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Tennessee queue?
Tennessee is on Central time, 11 hours behind Rawalpindi. The shift here runs 8pm to 4am so your seat is at a desk for your full working day, shifting to 7pm to 3am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle TennCare as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. TennCare has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your Tennessee work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com