Department of Development Disabilities Appeal Process - Quick reference

Department of Development Disabilities Appeal Process - Quick reference

Service (Grier) Appeals are submitted for denial of Med Waiver services. Thirty (30) days are allowed after you get the denial letter to appeal. **However, consideration should be given to submitting the appeal within ten (10) days of the notice when the service is to be terminated or suspended to ensure services continue through the appeal process**

***There are 3 ways to file a service appeal***

1. Mail: You can mail an appeal page or a letter about your problem to: TennCare Solutions Unit (TSU)
PO Box 000593
Nashville, TN. 37202-0593

To print an appeal page off the internet website go to:

OR, to have TSU mail you an appeal page, call them for free at 800-878-3192

2. Fax: You can fax your appeal page or letter for free to 888-345-5575

3. Call: You can call TSU Toll Free at 800-878-3192

Unless you have an emergency, please call during regular business hours. Business hours are Monday through Friday from 8 am until 4:30 pm CST. If you have an emergency you can call anytime.


Do you think you have an emergency?

Usually, your appeal is decided within 90 days after you file. BUT, if you have an emergency, you may not be able to wait 90 days. An emergency means that if care or medication is not provided sooner than 90 days:

  • There is a risk of serious health problems OR death
  • OR, it will cause serious health problems, OR death
  • OR, there is a need for hospitalization

Do you STILL think you have an emergency?

If so, you can ask TSU for an emergency appeal. Your appeal may go faster if your doctor signs your appeal saying that it is an emergency. What if your doctor doesn't sign your appeal but you ask for an emergency appeal? TSU will ask your doctor if your appeal is an emergency. If your doctor says it is not an emergency, TSU will decide your appeal within 90 days.

After your appeal is filed what's next:

1. If TSU overturns DIDDS denial, the following will happen:

  • TSI will issue a written directive to DIDDS with instruction to authorize and ensure provision of the services within 3 days.
  • You will receive written notification that the service was approved by TSU.

2. If the denial is not overturned by TSU and/or DIDDS will not reconsider denial or approve services as requested and you want to continue the appeal process, take the following actions:

  • Schedule an administrative hearing to be held either by phone or in person with the TennCare Office of General Counsel (OGC) at 877-778-3698

NOTE**TSU tvpically will refer the case to OGC with their denial and notify you of this in writing. You will need to follow-up with OGC to schedule and confirmm the hearing.

  • Request an expedited appeal hearing if this is considered an emergency situation otherwise a decision will be rendered within 90 days by the judge
  • Obtain and prepare documentation and testimony for the hearing
  • Be present and on time for the hearing

Eligibility appeals are submitted for denial and termination of eligibility (involuntary disenrollment)

Some cases getting eligibility reinstated may be as simple as updating information and submitting specific documentation to the entity indicated. The notice will provide information regarding what is needed and/or how to appeal and request a fair hearing and the deadline for submitting the appeal.

Ensure services continue if an appeal hearing is required:

  • Submit the appeal to DIDDS within ten (10) days of the notice and request that services continue while the appeal is pending

The following should be done in preparation  for and during the appeal hearing:

  • Make arrangements for a telephone or in person hearing
  • Obtain legal representation and/or provide testimony regarding needs and capabilities
  • Obtain records, information or hearing testimony from other providers to present to the judge to determine if eligibility criteria or requirements are met

Need help with your appeal: Contact your ISC or BGC at 1-615-377-0950 or toll free 1-877-743-0950


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