Significant no-fault and personal injury exposure, which puts the auto carrier ahead of the health plan in states that run PIP. In Tennessee that plays out against a specific set of rules rather than a general one.
Claims for Tennessee providers are adjudicated by Palmetto GBA (JJ), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Coding driver
Active treatment versus maintenance care — the distinction every review examines and the record has to make.
Medicare contractor
Palmetto GBA (JJ)
Medicaid program
TennCare
Auto injuries
Tort state — health plan sequencing applies
What changes in Tennessee
Medicaid in Tennessee runs as TennCare and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
Tennessee attaches criminal penalties to percentage-based fee-splitting arrangements. Our own pricing in Tennessee is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.
Where chiropractic claims fail
- Care characterized as maintenance rather than active treatment
- Missing initial evaluation supporting necessity
- Auto claims billed to the health plan first
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your Tennessee chiropractic denials.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes segmented by payer and provider.
Chiropractic Billing in Tennessee — Frequently Asked Questions
Do chiropractic billing rules differ in Tennessee?
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TennCare is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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