Request for TennCare Release

REQUEST FOR RELEASE. This form is used by the Division of TennCare's RFR Processing Unit by a person seeking to waive or delay the recovery of TennCare claims related to a deceased individual. The form requires details about the deceased person, including their name and Social Security Number, as well as information about the person submitting the request. If a probate court case has been filed, details about the case need to be provided. Additionally, the form asks about specific circumstances that may warrant waiver or delay of claim recovery, such as the deceased being survived by a child under 21 or by a blind or permanently disabled child. Information about any trusts with Medicaid payback provisions is also requested. Instructions are provided for submitting the form along with required documents, such as the deceased's death certificate, birth certificates of surviving children, long-term care insurance policy documents, and trust copies. The form also offers assistance in various languages and provides contact information for filing complaints or seeking help. www.FormsWorkflow.com