Actual Cost Appeal (TN)
EHIM accepts appeals from pharmacies asserting that they have not received reimbursement for at least actual cost for all prescription drugs, drug products, and devices paid for by EHIM.
A pharmacy must submit its Actual Cost Appeal to EHIM within seven (7) business days of its submission of the initial claim for reimbursement.
- EHIM has seven (7) business days from the date it receives all required documentation for processing an Actual Cost Appeal to make a final decision to grant or deny the pharmacy’s appeal.
- If a pharmacy decides to appeal EHIM’s denial of its Actual Cost Appeal to the TN Insurance Commissioner, the pharmacy must submit their appeal within thirty (30) days of receipt of EHIM’s appeal denial notice.
- Tennessee Pharmacy Actual Cost Appeals Policy
- TN Department of Commerce & Insurance Standard Pharmacy Reimbursement Appeal Form
- Please address all questions regarding this process to email@example.com
- Fax at (248) 948-9904. If faxing, please ensure an email address is included on your form so a response can be provided.