PHARMACIST CREDENTIALING, CONTRACTING, AND BILLING
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In 2017, Tennessee enacted Public Chapter 82, paving the way for pharmacists to be credentialed and reimbursed as medical providers in commercial health plan medical provider networks. Following on the heels of the enactment of a similar law in Washington state in 2015, Tennessee became only the second state to enact such legislation granting pharmacists recognition and payment as “providers”. Since the enactment of these important laws, similar laws have been enacted in additional states to increase patient access to compensated pharmacist-provided patient care services.
The following resources are designed to help you provide a broader range of services to patients and expand your pharmacy practice.
Some of the resources below require a TPA member login to access.
- Building a Patient-Centered Practice: Collaborative Practice, Credentialing and Provider Enrollment, and Opportunities for Pharmacists is a web-based educational training program created by TPA to support pharmacists in developing a patient-centered pharmacy practice. It provides (3) hours of ACPE-accredited continuing education focused on key aspects of pharmacy practice development.
- Tennessee Pharmacy Practice Guidebook is a reference book for Tennessee pharmacy professionals interested in learning why documentation is so critical for reimbursement and audit mitigation; how to utilize different billing methods; and how to utilize appropriate billing codes within a pharmacist’s scope of practice. It includes documentation for time and complexity-based billing methods, CPT® and ICD-10 Diagnosis codes for claims submission, and case studies showing how to translate documentation to billing code.
- Tennessee Handbook on Pharmacy and Drug Law is a compilation of Tennessee and federal laws affecting pharmacy in our state. Published by the Tennessee Pharmacists Research and Education Foundation and updated every year since 2008, the Handbook is a word-searchable and printable digital download/ebook.
- Clinical Pharmacy Pathway Certificate Training Program provides education and training to pharmacists in the areas of cardiology, endocrinology, pulmonology, medical credentialing, contracting, and billing. In partnership with the Centers for Disease Control and Prevention (CDC) and the Tennessee Department of Health (TDH), this program is intended to assist pharmacists in positioning themselves as providers of care and services.
- TPA is offering the Technician Product Verification Training Module, a program approved by the Pharmacy Technician Certification Board (PTCB). This program can lead pharmacy technicians to receive the Technician Product Verification Certificate from PTCB, which is a step toward earning an Advanced Pharmacy Technician credential. As pharmacists implement new services through collaborative practice, pharmacy technicians will need to be empowered to take on greater roles in pharmacy practice as well.
- Medication Therapy Management (MTM) in Medicaid is a Practice-Based Resource Page for TPA Members.
- Collaborative Pharmacy Practice is a Practice-Based Resource Page for TPA Members.
- Point of Care Testing is a Practice-Based Resource Page for TPA Members.
- Immunizations is a Practice-Based Resource Page for TPA Members.