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Administrative Manual Policy Manual Number: 200.040 Section: General Administrative Procedures and Compliance Chapter: Eligibility Determination

June 2, 2025 Division of TennCare 2

All processing delays must be fully explained and documented in the individual’s case notes.

3. Withdrawn Applications

If an application is withdrawn, document the individual’s request to withdraw an application in the case notes and issue a notice to the individual regarding the withdrawn application.

4. Unable to Locate an Individual

If notified that the individual has changed her location or contact information, attempt to locate the individual and document all efforts to locate the individual in case notes, including phone calls and written requests for contact. Include the following about all sources of information or verification:

a. Identity of the source; b. Relationship or connection to the individual; c. Type of contact: written correspondence, telephone contact, personal contact, etc.; d. Date of contact, correspondence or pay stubs; and e. The nature of the information provided by the source.

If the individual does not respond to verification requests, a termination notice will be issued. If TennCare is notified that the individual no longer lives in Tennessee, TennCare will attempt to verify Tennessee residency. A termination notice will be issued if verification is not received.

5. Individual is Deceased

Once an individual’s death has been verified, the date of death must be entered in the individual’s case.

6. Case Documentation

All facts used by TennCare to substantiate an eligibility determination are recorded in the individual’s electronic case. TennCare will record all pertinent information and documentation reviewed, or online verifications obtained or used in the eligibility determination process (i.e., birth certificate, Medicare information, property deed, etc.). Pertinent information and facts include, but are not limited to:

a. Type and date of document used, information verified by the document, form or document number, name and title of signatory on document; and b. Date the documentation is viewed and by whom

Note: TennCare does not retain original documents and will return original documents after