For physicians and healthcare professionals
Provider Pathways is a 24/7 educational resource that offers a foundation for doing business with Wellpoint in Tennessee. It is designed to be user friendly and gives you flexibility when scheduling training for yourself and your staff. In order to launch the Provider Pathways eLearning, please complete TN Provider Pathways registration.
MANUALS & GUIDES
The provider manual provides key administrative information, including the quality improvement program, the utilization management program, quality standards for participation, claims appeals, and reimbursement and administration policies for Medicaid and Medicare recipients.
Fraud, waste, and abuse (FWA)
The Tennessee Bureau of Investigation Medicaid Fraud Control Division (TBI MFCD) is the state agency responsible for the investigation of provider fraud, waste, and abuse in the TennCare program. Wellpoint and its network providers are required to cooperate with all state and federal agencies, including TBI MFCD and OIG, in investigating or prosecuting FWA.
Providers can find more information on preventing, detecting, and reporting FWA by referring to your Medicaid and Medicare provider manuals.
Trainings and tutorials
Wellpoint offers training and tutorials to support providers in continuing their education. Presentations, videos, and other training documentation will be added as they become available.
Training opportunities for behavioral health providers
Sign up with Psych Hub , our new training partner for our behavioral health providers. You’ll gain access to Psych Hub’s catalog of educational podcasts, videos, and other accredited content. You’ll also gain the opportunity to receive free continuing education units, a requirement for most professional licenses. Numerous self-paced courses in evidence-based interventions are ready for you.
Additional provider training resources
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Policies, guidelines & manuals
- Training academy
- Pharmacy information
- Electronic data interchange (EDI)