BCBST.com

• NEWS – TennCare Transition in West and East Grand Regions – Letters to providers and frequently asked questions
• QUICK LINKS- Provider Manual -The Volunteer State Health Plan Provider Administration Manual contains comprehensive information regarding BlueCare® operating policies and procedures. The information contained in the manual applies to Providers who care for BlueCare and/or TennCareSelect Members.
• BLUECARE® / TENNCARESELECT-
  • State of Tennessee Website Information Update
  • Amended and Restated Contractor Risk Agreement – West and East MCO contract
  • Provider Initiated Notice - Adverse Action (Electronic Form)
  • Provider Initiated Notice - Adverse Action
  • Crisis Information
  • Disclosure of Ownership & Control Interest Statement
  • State Medicaid Director letter
  • P4 Pathway Oncology Program

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TennCare Programs & Services

Important Information February 1, 2011

CaringStart Maternity Management Program

The CaringStart Maternity Management program partners with providers to improve the health and birth outcomes of our pregnant members.

CareSmart Disease Management Programs

CareSmart Disease Management Programs partner with providers to improve the health and quality of life for members with chronic disease and illness. The programs emphasize the importance of primary care provider collaboration and involvement.

High Tech Imaging Services

As of November 1, 2008, prior authorization may be required for CT, CTA, MRI, MRA, MR Spectroscopy, PET Scans, and Nuclear Cardiology imaging services for BlueCare members in the West Grand Region.  These prior authorization requirements will also apply to members in the East Grand Region on January 1, 2009.

Medication Dispensed in Physician's Office

Certain self-administered medications should not be dispensed in a physician’s office.  Claims for certain oral, topical and self-administered injectable drugs should be submitted through the BlueCare and TennCareSelect member’s pharmacy benefits manager. Practitioners should write a prescription and have the member obtain these drugs from their pharmacy.

Select Community

This is the new TennCare Select program for certain persons with Intellectual Disabilities  Members have Nurse Care Managers to assist them with getting their physical and behavioral health needs met.  Please click on the link for additional information.

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5010 Implementation - Changes to Provider Claims Formats

As of January 1, 2012, all BlueCare/TennCareSelect claims must be submitted in the 5010 format. This impacts electronic claims, as well as claims submitted on the CMS-1450 and CMS-1500 paper claim forms.  All providers listed on claims must be reported in a manner that is compliant with established guidelines.  Additional information may be found in the documents below.

Letters to Providers

• VSHP Provider Letter
• BCBST Provider Letter

Usage Grid

CHOICES

CHOICES was designed to provide streamlined, timely access to LTC services, expand access to and utilization of cost-effective HCBS alternatives to nursing facility care, serve more people with existing LTC funds, increase HCBS options, improve coordination of all Medicaid services, and rebalance LTC spending.

CHOICES Directory of Services 

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Important Provider Links

• Electronic Health Record Update 4/28/11
• Medical Emergency Code List (sorted by description) 
• Medical Emergency Code List (sorted by code) 
• BCBST.com provider news 
• Specialty Pharmacy Drug List 
• VSHP Provider Manual 
• Amended and Restated Contractor Risk Agreements 
• Federal VFC Guidance on New CPT Codes for Vaccine Administration
• TennCare Member Appeal Poster 
• Specialty Pharmacy Medications Requiring Prior Authorization
• 07/01/11 Bureau of TennCare Memo and False Claims Act Clarification
• Additional Clarification of the Violation of the Medicaid False False Claims Act Clarification
• CareCentrix Provider Portal Information
• VFC Guidance August 2011
• Non-discrimination Compliance Training