Out-of-Network (NonPar) Providers
Payment and Enrollment Information
As a Tennessee Medicaid Health Plan, VHP CommunityCare is required by Federal, State and Bureau of TennCare mandates to obtain specific information from all Out-of-Network (NonPar) Providers before services rendered to a TennCare Enrollee can be reimbursed. All claims will be pended until this information is received. Please note – you cannot balance bill a Medicaid Beneficiary.
Link to Apply for Tennessee Medicaid Provider Number:
http://www.state.tn.us/tenncare/Providers/enroll.html
Notice to NonPar Facility Providers
Forms for completion by NonPar Facility Providers:
VHP Provider Load Form
Disclosure of Ownership Form
Forms for completion by NonPar Physicians:
VHP Provider Load Form
Criminal Attestation Form
CMS 1513 Form (if applicable)
All required forms must be completed and mailed or faxed to:
VHP CommunityCare
Attention Provider Relations Department
7100 Commerce Way, Suite 285
Brentwood, TN 37027
Fax: (615) 782-7876
Please call our Provider Services Department if you have questions or need additional assistance at (615) 782-7878.