AR Recovery for Tennessee Medical Practices

We work your aged and denied claims against Tennessee's own payer rules, including TennCare's three health plans, inside the EHR you already use, and we are paid on what comes back.

  • 12 to 15% of what we recover
  • 30+ EHR integrations, no migration
  • Free RCM audit in 3 to 5 business days

Find out what is still collectible

We return a line-by-line recoverable revenue estimate by payer. 3 to 5 business days. No obligation.

We only need aging totals to start. Do not send patient data.

Not sure where your balances stand? Start with a free audit.

Tennessee payers

Who pays a Tennessee practice, and what each one changes

A Tennessee practice is paid mainly by TennCare's health plans, commercial insurers led by BlueCross BlueShield of Tennessee, and Medicare through Palmetto GBA. Each runs its own clock. TennCare adds a dispute route most states do not have: independent review under state law. Aged AR is recovered by working each balance against the rule that actually governs it.

TennCare

Three health plans, not one

Nearly all TennCare members are enrolled in one of three health plans: BlueCare Tennessee, UnitedHealthcare Community Plan or Wellpoint (formerly Amerigroup). TennCare Select covers certain special populations. BlueCare is run by Volunteer State Health Plan, a BlueCross BlueShield of Tennessee subsidiary.

Each plan sets its own prior authorization rules, fee schedule and claims process, so TennCare AR has to be worked plan by plan. Each plan also credentials separately; see credentialing with each TennCare plan.

Source: tn.gov/tenncare, Managed Care Organizations

TennCare claim disputes

Reconsideration, then independent review

Reconsideration with the health plan comes first. After that, Tennessee law gives providers independent review of claims a TennCare plan denied in whole or in part. The TennCare Oversight Division at the Department of Commerce and Insurance administers the process, and an outside reviewer decides. What matters for AR, from the statute:

  • Request it within 365 days of the plan's first denial or recoupment.
  • Include a copy of the written reconsideration request.
  • The reviewer considers only what the provider gave the plan during the plan's own review. Everything has to go in at reconsideration.
  • Claims that share a common question of fact or law can be aggregated into one request.
  • Claims denied by a plan's subcontractor are eligible.
  • Claims already in litigation or arbitration are not.

The state lists a reviewer fee of $750 per request, or $450 if the dispute settles before a decision. Aggregating claims that share one denial reason keeps that cost to one request.

Source: Tenn. Code Ann. 56-32-126(b)(2) · tn.gov, Independent Review Process

Commercial prompt pay

Tenn. Code Ann. 56-7-109

Clean claims must be paid within 21 days of electronic receipt or 30 days of paper receipt. Unpaid amounts after the due date carry interest of 1% per month.

The statute excludes from the definition of a clean claim any claim submitted more than 90 days after the date of service. The consequence is practical: file inside 90 days, or the prompt-pay deadline and the interest no longer protect that claim.

Source: Tenn. Code Ann. 56-7-109

BlueCross BlueShield of Tennessee

Largest health plan company in the state

Third-party billing sites disagree on BCBST's filing limit, listing anything from six months to 365 days. The answer depends on the product, and the only reliable source is BCBST's own Provider Administration Manual for that product. We check the manual for each claim's product rather than trusting a list.

BlueCare crossover claims run on a different clock from standard claims: 365 days from the date of service or 180 days from the paid date on the Medicare or D-SNP EOB, whichever is greater.

Source: BCBST Provider Administration Manuals · BCBST BlueAlert, June 2026

Medicare

Palmetto GBA, Jurisdiction J

Part B claims from Tennessee go to Palmetto GBA, the Jurisdiction J Medicare Administrative Contractor. The initial claim must be filed within 12 months of the date of service.

Source: CMS MAC directory · 42 CFR 424.44

Engagement

How the engagement runs for a Tennessee practice

The method is the same everywhere; see how AR recovery works. What changes in Tennessee is how TennCare balances are sorted and disputed. We work remotely, inside the EHR you already use.

  1. 01

    TennCare triaged by health plan

    BlueCare, UnitedHealthcare Community Plan and Wellpoint balances are sorted and worked separately, against each plan's own rules. TennCare is never treated as one payer.

  2. 02

    Reconsideration packets built complete

    Every record and argument goes into the first reconsideration, because independent review only sees what the plan saw.

  3. 03

    The 365-day review window tracked per claim

    Each denied TennCare claim is dated from its first denial or recoupment, so the independent review deadline is known before it arrives.

  4. 04

    Shared denials grouped

    Claims denied for the same reason are grouped so they can go to independent review as one aggregated request.

  5. 05

    Late-paid commercial claims checked for interest

    Clean commercial claims paid after the 21-day or 30-day deadline are checked for the 1% monthly interest owed.

Comparison

Before and after working with Quilven

A process comparison drawn from one engagement outside Tennessee. Not a record of a Tennessee practice and not a promise of outcome.

AreaBeforeWith Quilven
Rejection ownershipNobody owned the rejection queue, and rejected claims went untouched for nearly a year.Rejections are worked within four to five days, while each claim can still be refiled.
Coordination of benefitsOther-coverage details were never refreshed with patients, so the same claims denied again and again.Other coverage is confirmed by calling the patient, and crossover claims are timed to the secondary plan's window.
Payer routingClaims went to a parent plan when a subsidiary with its own claims unit was responsible.TennCare claims go to the member's own health plan, confirmed at eligibility, not to "TennCare".
EligibilityPatients were seen on coverage that had already ended, and the claims went out anyway.Coverage and health plan assignment are checked before the visit.
Member and group IDsOne formatting error in a member ID sat in the record for months.Demographic fields are matched to the plan's record before the claim is sent.
Lab claim attributionThe group NPI was used where the ordering physician belonged, and the CLIA level did not fit the code.The ordering physician's NPI is in box 17 and the CLIA level matches the code billed.
ModifiersWaived tests went out without QW, and 25, 59 and RT were missing where needed.Modifiers are checked by code family before submission.
Timely filingRejections came to light long afterward, with no proof the claims had ever been submitted.Commercial claims are filed inside 90 days to keep prompt-pay protection, TennCare review windows are tracked per claim, and proof of submission is kept.

Which of these applies to your claims is a question the audit answers.

Deadlines

What is still recoverable under Tennessee rules

A Tennessee claim is recoverable while its window is open, or if you can prove it was filed on time. For a denied TennCare claim, the window that usually matters most is independent review: 365 days from the first denial, provided the reconsideration was complete. Each TennCare plan's own filing and reconsideration limits come from that plan's provider manual and are checked claim by claim. See which Tennessee claims are still workable.

RuleDeadlineSource
TennCare independent review365 days from the plan's first denial or recoupmentTCA 56-32-126(b)(2)
Commercial prompt pay21 days electronic, 30 days paper; 1% interest per month afterTCA 56-7-109
Prompt-pay "clean claim"Excludes claims submitted more than 90 days after date of serviceTCA 56-7-109(a)
BlueCare crossoverGreater of 365 days from DOS or 180 days from the Medicare or D-SNP EOB paid dateBCBST BlueAlert, June 2026
BCBST commercial filingSet by product in the BCBST manual; checked per claimBCBST Provider Administration Manual
Medicare12 months from date of service42 CFR 424.44

Last checked: 3 Oct 2026

You can run your claims against these windows in the browser, with no patient data.

Case study

Where the $5,500 was hiding

One AR recovery engagement, at a family medicine practice in Minnesota, not Tennessee. Shown for method. Individual results vary. One engagement is not a forecast.

The work covered 245 claims. The rejection queue had no owner, and about a year of rejections had piled up in it.

Found in the queue: roughly $40,000 to $50,000 in billed charges that no one had touched.

Most of the damage started before the claim was built. Outdated coverage, incorrect member IDs and skipped eligibility checks at the front desk explained 70% of the denials.

Not everything could be saved. On most of the affected claims, a commercial payer's 90-day filing window had already closed, and with no proof of submission there was nothing to appeal on.

Paid: about $5,500 on 50 to 55 claims, most of it within 45 to 50 working days.

Read the full Minnesota write-up.

In their words

What the physician said

What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
Physician, family medicine practice in Minnesota
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
Physician, family medicine practice in Minnesota
I appreciate the professionalism, the courtesy, the knowledge.
Physician, family medicine practice in Minnesota

After the audit the practice changed how it runs: eligibility verified before arrival, no more walk-ins, every patient checked the night before.

Pricing

What AR recovery costs

Same pricing as every Quilven engagement, with nothing Tennessee-specific. See pricing in full.

AR recovery

12 to 15%

of the recovered amount

No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.

Medical billing

3 to 5%

of collections by monthly volume

A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.

Credentialing

$150 to $250

per provider per payer

Priced per enrollment so you can see exactly what each payer application costs before it starts.

Fit

Fit with your EHR

Recovery work does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.

This matters because the usual objection to outside AR help is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on your existing inventory rather than after a build-out.

What you do get is visibility. Apex is our client dashboard, and it shows in real time:

  • Net collection rate
  • AR aging by bucket
  • Denial reasons by payer
  • Credentialing pipeline

Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.

Company

Who Quilven is

Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.

Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $250 per provider per payer.

The entry point is a free RCM audit. It takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.

We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick and works from 159 4th Ave N, Suite 100, Nashville, TN 37219. The entity is registered in Wyoming. Reach us at (202) 490-9406 or info@quilven.com.

Our office is in Nashville. Work for Tennessee practices is done remotely, inside the practice's own EHR.

Fit

Who this is for

Independent Tennessee practices with 3 to 25+ providers that have TennCare health plan denials or BCBST claims aging toward their windows, and no one with the time to build complete reconsiderations before those windows close.

If the backlog is a one-time problem, you can clear an aged backlog in one project instead of an ongoing engagement. If you want a number first, estimate what your aged AR is worth.

It is not for hospitals billing facility claims.

At a glance

AR recovery service facts

Service
Managed AR recovery for independent medical practices
Service type
Accounts receivable recovery and denial root-cause correction
Delivery model
Managed service, not software, not an EHR
Systems
30+ EHR and practice management integrations, no data migration
Practice size served
3 to 25+ providers, independent and physician-owned
Inventory worked
Unpaid claims in filing window, claims past 90 and 120 days, underpayments, patient balances
Pricing
12 to 15 percent of the recovered amount, no fee on what is not recovered
Entry point
Free RCM audit, 3 to 5 business days, recoverable estimate by payer
Reporting
Apex dashboard: net collection rate, AR aging by bucket, denial reasons by payer, credentialing pipeline
Area served
United States
Data handling
Aging totals only to start, no patient data required

FAQ

Tennessee AR recovery questions

Start with a written reconsideration request to the health plan that denied the claim, not to TennCare. If the plan upholds the denial, Tennessee law allows independent review, administered by the TennCare Oversight Division. The request must be made within 365 days of the plan's first denial or recoupment and include a copy of your reconsideration request.

Under Tenn. Code Ann. 56-32-126, the independent reviewer considers only what the provider gave the plan during the plan's own review. Records or arguments added later are not considered. A thin reconsideration can lose a claim that a complete one would have won, so everything goes in the first time.

Yes, for clean commercial claims. Tenn. Code Ann. 56-7-109 requires payment within 21 days of electronic receipt or 30 days of paper receipt. Amounts unpaid after that deadline carry interest of 1% per month. TennCare health plan claims follow separate prompt-pay rules.

Yes. Under Tenn. Code Ann. 56-7-109, a claim submitted more than 90 days after the date of service is not a clean claim. It can still be payable under the payer's own filing limit, but the 21-day and 30-day deadlines and the interest no longer apply to it.

Quilven's office is in Nashville. Claims are worked remotely, inside your existing EHR and practice management system, with no data migration and no change to how your staff already works.

Next step

Start with a free RCM audit

The audit takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.

Answer three questions below and book a line-by-line audit of your Tennessee claims.

Where it leaks
Oldest claim
Practice size
Your details

Where is the money leaking right now?

Pick the one that hurts most. We start there.

(202) 490-9406 · info@quilven.com · Book 15 minutes