Form IN-2001 Request to Commissioner for Independent Review of Disputed Provider Claim - Tenncare & Coverkids Programs - Tennessee

What Is Form IN-2001?

This is a legal form that was released by the Tennessee Department of Commerce and Insurance - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the purpose of Form IN-2001?A: The purpose of Form IN-2001 is to request an independent review of a disputed provider claim in the Tenncare & Coverkids programs in Tennessee.

Q: Who can fill out Form IN-2001?A: Form IN-2001 can be filled out by providers participating in the Tenncare & Coverkids programs in Tennessee who have a disputed claim.

Q: How do I submit Form IN-2001?A: Form IN-2001 can be submitted by mail or fax to the address or fax number provided on the form.

Q: What information is required on Form IN-2001?A: Form IN-2001 requires information about the disputed claim, including the provider's contact information, claim details, and the reason for the dispute.

Q: What is the deadline for submitting Form IN-2001?A: The deadline for submitting Form IN-2001 is 45 days from the date of the initial claim determination.

Q: What happens after I submit Form IN-2001?A: After submitting Form IN-2001, the request for independent review will be reviewed by the Commissioner, who will make a determination on the disputed claim.

Q: Can I appeal the Commissioner's decision?A: Yes, if you disagree with the Commissioner's decision, you have the right to appeal the decision within 30 days of receiving the determination.

Q: Can I get assistance in filling out Form IN-2001?A: If you need assistance in filling out Form IN-2001, you can contact the Tenncare Bureau of TennCare Services for guidance.

Q: Is there a fee for submitting Form IN-2001?A: No, there is no fee for submitting Form IN-2001.