Tennessee's Therap Billing Switch: What IDD Providers Need to Know

On July 1, 2024, Tennessee rewired how IDD providers get paid. Billing for 1915(c) waiver services, Katie Beckett Part B, and state-funded IDD services moved from the legacy PCP system into Therap — and payment shifted from TennCare directly to the three contracted managed care organizations: BlueCare, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup).

For agencies that weren't paying close attention, this transition landed as a billing system overhaul, a payer relationship change, and an EVV requirement update all at once.

What the Therap Transition Actually Changed

Before July 1, 2024, IDD providers billed through the PCP portal and received payment from TennCare. After July 1, 2024, billing happens in Therap, claims use industry-standard HCPCS codes instead of legacy DDA service codes, and payment comes from the MCO tied to that member — not TennCare.

The change also restructured how service authorizations work. Providers are now required to acknowledge service authorizations in Therap for dates of service July 1, 2024 forward. Legacy cost plans are no longer valid for services after June 30, 2024. Any provider still working from old cost plans or submitting through PCP for post-July 2024 dates of service is billing against a structure that no longer exists.

How EVV and Billing Connect in Therap

The Therap transition made EVV directly load-bearing for payment. Therap sends EVV data to DIDD for applicable services. DIDD validates the data and determines whether the service meets billing requirements. If valid — meaning a clean check-in and check-out by the worker — the provider is automatically paid without manual claim submission.

That's the upside. The downside is that any visit where the EVV record is invalid, incomplete, or missing doesn't generate automatic payment. There's no workaround that substitutes for a valid EVV record in the Therap system. Providers with workers who forget to check out, clock in from the wrong location, or skip EVV steps aren't just generating compliance flags — they're blocking their own payments.

The MCO Layer for CHOICES Providers

For providers serving CHOICES and ECF CHOICES members, the EVV picture is slightly different. MCOs — particularly Wellpoint — use CareBridge as their EVV system for applicable services. Providers need to be clear on which EVV system applies for which program and which MCO, because submitting claims through the wrong channel or with mismatched EVV data creates the same result: no payment.

ECF CHOICES expanded its coverage for Group 2 and Group 3 members in July 2025, adding employment services and enabling technology options. As the program grows, the volume of MCO-routed claims grows with it — and so does the importance of clean EVV workflows for each MCO's specific requirements.

What Providers Should Audit Now

Confirm that all active service authorizations have been acknowledged in Therap for July 2024 forward. Verify that HCPCS codes are correct — legacy DDA service codes are no longer accepted. Pull your EVV compliance data in Therap and identify any workers with patterns of missing check-outs or failed validations. And for CHOICES members, confirm CareBridge integration is active and routing correctly for each MCO.

Tennessee's 2024 transition was designed to modernize IDD billing. For agencies that completed the transition cleanly, it did. For agencies still working through code mapping, service authorization gaps, or EVV workflow problems, the billing consequences are direct and ongoing.