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MEDICATION THERAPY MANAGEMENT (MTM)

ALL TPA PRACTICE-BASED RESOURCES:

Coronavirus (COVID-19) Medication Therapy Management (MTM) Immunizations Statewide Naloxone CPP Pharmacist-Provided Hormonal Contraceptives
Pharmacist Credentialing, Contracting, and Billing
Point of Care Testing Collaborative Pharmacy Practice Pharmacy Benefits Manager (PBM) Laws Opioid and Prescription Drug Abuse

CLICK HERE  to access the “Medication Therapy Management” resources listed below — EXCLUSIVELY FOR TPA MEMBERS.

If you need help logging in to your TPA member account, please click here for instructions, or contact TPA. If you’re not a member and would like to join TPA, please click here!


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.


GENERAL INFORMATION

  • 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