Effective January 1, 2015, BlueCare Tennessee assumed responsibility for behavioral health contracting and credentialing for the BlueCare, TennCareSelect, CoverKids, and BlueCare Plus (HMO SNP) SM networks. The intent is to be contracted with providers directly under the same terms and rates that existed with Value Options, Inc.
Please also keep in mind:
January 1, 2015 – Earliest network effective date. Providers, from whom a contract was not received, began receiving reimbursement at out-of-network rates.
New Guidelines: MCG Guidelines (formerly, Milliman Care Guidelines) went into effect Jan. 1, 2015.
Call the appropriate line below:
Contact Utilization Management Monday ‐ Friday, 8 a.m. to 6 p.m. (ET) at:
For behavioral health administration forms, refer to the following page in the Provider section of this website:
Provider Education and Resources / Forms
For helpful tools and other resources, refer to the following page in the Provider section of this website:
Provider Education and Resources / Training and Tools
NAS may be a tough subject for parents, so the NICU works with the Children's Hospital Social Work Department if needed. Intervention begins with Silver Linings at East Tennessee Children’s’ Hospital (ETCH).
The MIST (Mothers & Infants Staying Sober) team consists of a case manager, a counselor and a program manager who work together to support and care for families struggling with substance abuse.
BlueCare Tennessee Web Authorizations are accessed through your BlueAccess account which:
For help registering with BlueAccess, see:
Register with BlueAccess
Web Authorization Contacts:
Message Lines (non-technical authorization issues)
BlueCare / TennCareSelect423-535-4968
BlueCare Plus 866-789-6314
eBusiness Service Center
(technical authorization or BlueAccess issue) 423-535-5717 Option 2
West TN: Debbie Angner
Middle TN: Faye Mangold
East TN: Faith Daniel
The CAQH Universal Provider Datasource (UPD) is the industry standard for collecting provider data required by health plans, hospitals and other managed care organizations for credentialing, claims processing, quality assurance, emergency response, member services, and more. UPD enables physicians and other health professionals in all 50 states and the District of Columbia to submit their information free of charge into a secure, centralized database through an interview-style online process.
Large provider groups received the following letter in December, 2014 informing them BCBST will require new credentialing applications for practitioners to be submitted through the CAQH beginning 1/1/15. Provider_Notification_120314_CAQH_Crendentialing
A quick reference guide is available on the CAQH website: http://www.caqh.org/pdf/UPDbrochure.pdf.
Facilities are not eligible for credentialing through CAQH at this time. Provider Groups or Practitioners with questions may contact their local Provider Relations Consultant (PRC) or the regional number below to be referred to their PRC.