TN : Tennessee State Government 2025

1. Click ‘Get Form’ to open the TN : Tennessee State Government document in the editor.
2. Begin by filling out the personal information of the person appealing. Include their full name, date of birth, Social Security Number or TennCare card number, and current mailing address.
3. Identify who is completing the form. If it’s not the person appealing, provide your name and select your relationship to the individual (e.g., parent, advocate).
4. Indicate the reason for the appeal by placing an 'X' next to one of the options provided (changing health plans, needing care or medicine, or disputing bills).
5. If applicable, answer whether you believe there is an emergency situation that requires expedited processing of your appeal.
6. In Part A, B, or C on page 2, provide detailed information regarding your specific appeal issue. Be sure to include any relevant facts and documentation.
7. Once completed, save your document and either mail it to TennCare Solutions or fax it using the provided contact details.

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