THE CHATTANOOGA-HAMILTON COUNTY HOSPITAL AUTHORITY D/B/A ERLANGER HEALTH SYSTEM V. UNITED HEALTHCARE PLAN OF THE RIVER VALLEY, INC. D/B/A AMERICHOICE AND TENNESSEE ATTORNEY GENERAL - Articles

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Posted by: Brittany Sims on Jun 9, 2014

Court: TN Court of Appeals

Attorneys 1:

James Nathaniel Bowen, II, Steven Allen Riley, Nashville, Tennessee, for the appellant, The Chattanooga-Hamilton County Hospital Authority d/b/a Erlanger Health System.

Attorneys 2:

Erin Palmer Polly, J. Mark Tipps, John C. Hayworth, Nashville, Tennessee, for the appellee, UnitedHealthcare Plan of the River Valley, Inc. d/b/a AmeriChoice.

Robert E. Cooper, Linda A. Ross, Sue Ann Sheldon, Nashville, Tennessee, for the appellee/intervenor, Tennessee Attorney General.

Judge(s): COTTRELL

Hospital filed an action against TennCare managed care organization (“MCO”) for breach of contract and unjust enrichment when MCO refused to pay Hospital’s standard charges for emergency services and follow-up care. Hospital was not part of MCO’s “provider network” under the TennCare regulations and therefore was “non-contract” provider. MCO alleged Hospital was required to accept as payment the rate TennCare specified in its regulations. MCO filed motion for summary judgment, and the trial court dismissed the portion of the complaint to which the TennCare regulations may apply due to lack of subject matter jurisdiction. The trial court determined the Uniform Administrative Procedures Act (“UAPA”) divested it of jurisdiction because Hospital did not first seek a declaratory order from the Bureau of TennCare regarding the applicability of its regulations to Hospital’s dispute with MCO. Hospital appealed the dismissal of its claims, and we reverse. Because Hospital is not challenging applicability or validity of TennCare regulations, UAPA does not divest trial court of jurisdiction.