provider: means any person or entity performing services regulated pursuant to title 63 or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract. See Tennessee Code 56-7-3301
State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
(1) A health insurance entity shall provide notice to a healthcare provider of any material change made in the sole discretion of the insurance entity to the entity’s previously released provider manual or a reimbursement rule and policy at least sixty (60) days prior to the effective date of the change, and the health insurance entity shall ensure that any such material change is clearly identified in the following manner:
(A) Disclosing or identifying the change in the provider manual through the use of bold print or a font, or both, with the bold print or font being the same or larger size as the font generally used throughout the policy or manual; and(B) Disclosing or identifying the change in the reimbursement rules and policies and the effective date of the change through the use of a separately categorized communication to the provider.(2) Any disclosures required under this subsection (a) may be distributed by either:
(A) An internet web-accessible section associated with a web-accessible current version of the provider manual or reimbursement rules and policies; or(B)Written communication sent to a dedicated email address or as stipulated in the contract between the provider and the health insurance entity. The provider shall submit to the health insurance entity a dedicated email address to receive the disclosures required by this subsection (a).(b) Notwithstanding any law to the contrary, nothing in this part shall apply to the TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in part 29 of this chapter; any other plan managed by the health care finance administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27; or a contract between a healthcare provider and the state or federal government or their agencies for health services provided through Medicare.
