MEDICATION THERAPY MANAGEMENT (MTM)
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|If you are interested in participating in the MTM in Medicaid Pilot Program, please email MTMpilot@tnpharm.org. 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 Clinical Coordination Toolkit (CCT).
For links to details about the MTM in Medicaid information listed below, visit our members-only MTM in Medicaid page.
- 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)
- STEP 7: Agree to TennCare Privacy Policies
- STEP 8: Provide MTM Services and Submit Claims