If you have received a remittance advice with claims stating "Provider ineligible –see info on www.mmcc-tlc.com" and the reason code PRVIN, this page contains information on how to correct your provider record so that you are eligible for consideration of your claims.

There are numerous state and federal laws that TLC Family Care Healthplan must comply, among those being that all providers must have a Tennessee Medicaid ID number. If you already have a Tennessee Medicaid ID number, TLC does not have your Medicaid ID number on file.  If you do not have a Tennessee Medicaid Provider ID number, you can obtain the form and filing instructions to obtain a Tennessee Medicaid Provider ID number by clicking 
http://www.state.tn.us/tenncare/pro-forms.html 
Upon receipt of your Tennessee Medicaid Provider ID number, you can  fax the information along with your TLC assigned Provider ID number to Attn: Provider Relations at 901-725-2846.

Another requirement is that TLC have on file a criminal conviction disclosure form for all individual practitioners or an ownership and disclosure form for all facilities. To obtain the correct form and submission instructions for this form, please select the appropriate type of provider below:

Provider Ineligible Disclosure Forms

Disclosure of Ownership & Control Interest Statement

The above information must be received within one hundred eighty (180) days of the date of the TLC remittance advice with the provider ineligible claims. Failure to submit the above information within this timeframe will result in your claim being ineligible for reconsideration. Upon receipt of the above information, TLC will reprocess your claim without further action on your part.

If you think the above information is not applicable to you, there may be other issues with the provider ID number submitted on the claim. If you have questions, please contact TLC Provider Relations at (901) 725-7100 or (800) 473-6523.