Medical Billing Services in Tennessee

PRMS Billing Solutions provides complete billing and revenue cycle management for Tennessee providers, from Nashville and Memphis groups to Knoxville, Chattanooga, and rural TN. Tennessee's billing identity is TennCare, a fully managed Medicaid program running since 1994, paired with a commercial market that Blue Cross Blue Shield of Tennessee dominates from Chattanooga. We run eligibility, coding, claims, denials, AR, and credentialing end to end.

Medicare billing in Tennessee

Tennessee Part B claims are processed by Palmetto GBA, the Medicare Administrative Contractor for Jurisdiction J. We submit to Palmetto daily and screen against its local coverage determinations. Medicare Advantage is strong across TN, led by Humana (a hometown mid-South force), UnitedHealthcare, Aetna, and BlueAdvantage from BCBST, so MA enrollment is confirmed at eligibility on every Medicare patient.

TennCare billing

TennCare replaced fee-for-service Medicaid entirely three decades ago, so every member sits with a managed-care organization: BlueCare Tennessee (BCBST), Wellpoint (formerly Amerigroup), and UnitedHealthcare Community Plan. Each MCO keeps its own portal, prior-auth list, and filing window, and TennCare's regional history still shapes plan mixes across East, Middle, and West Tennessee. We verify the member's MCO before the visit and file with the right authorization attached.

Commercial payers we bill in Tennessee

Blue Cross Blue Shield of Tennessee is the state's dominant commercial payer, and its Network S/P/E tiering decides how claims pay for many employer plans. Alongside BCBST we bill Cigna (a major Memphis and Nashville employer book), UnitedHealthcare, Aetna, and Humana. Nashville's healthcare-corporate economy (HCA and its peers) adds a dense self-funded employer market with TPA-administered plans we route correctly at eligibility.

Specialties we serve across Tennessee

We bill 25+ specialties across Tennessee, including its busiest fields: family medicine, internal medicine, orthopedics, cardiology, behavioral health (with TennCare's carve-out history), pain management, and urgent care.

Why Tennessee practices choose PRMS

Tennessee's recurring leaks: TennCare claims filed to the wrong MCO, BCBST network-tier surprises that turn into underpayments, and self-funded TPA claims misrouted as fully insured. We sort payer, plan, and network before the visit, appeal what is wrongly denied, and report weekly so you see every dollar's status. Credentialing with TennCare MCOs, BCBST, and every major Tennessee payer is free for billing clients.

Related services

Explore our full medical billing & RCM services, denial management, and provider credentialing & payer enrollment (free for billing clients), or browse all 25+ specialties we bill and other states we serve.