BlueCare Tennessee is your health plan that helps you get physical, behavioral health and long term services and support. Listed below are some of the most frequently asked questions.Eligibility
In order to be eligible for TennCare as a new applicant, you must first qualify for TennCare Medicaid. To find out if you qualify:
To appeal your Marketplace eligibility results, log into your Marketplace account at HealthCare.gov
You can also mail an appeal request form or your own letter requesting an appeal to:
You can appeal the following kinds of Marketplace decisions:
If you would like more information on filing an eligibility appeal, you can also call 1-800-318-2596 or (TTY: 1-855-889-4325).
A new member should receive an ID card within seven to ten business days of when we receive your eligibility information from the State Bureau of TennCare. If you have not received your ID card, please call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-262-2873. Your doctor can call BlueCare/TennCareSelect to verify your coverage while you wait on your new ID card.
You may appeal by phone by calling Tennessee Health Connection at 1-855-259-0701 (Toll-free, Monday – Saturday, 7 a.m. – 7 p.m. CT). Or you may appeal in writing. If you choose to appeal in writing, use a plain piece of paper and include the information below:
Mail the appeal to:
Tennessee Department of Human Services
Division of Appeals and Hearings
P.O. Box 198996
Nashville, TN 37219-8996
There are six different benefit packages for adults age 21 and older who have TennCare. Look at your TennCare card to find out which benefit package you have and refer to your member handbook to find out what is included in that benefit package. All TennCare covered services must be medically necessary, as defined in TennCare rules. The definition of medically necessary is in the Legal Definitions section of your member handbook. For more information on Covered Services and Exclusions, go to http://www.tn.gov/tenncare/mem-covered.shtml .
There are two different benefit packages for children under age 21. Look at your child's TennCare card to find out which benefit package your child has and refer to your member handbook to find out what is included in that benefit package. All TennCare covered services must be medically necessary, as defined in the TennCare rules. The definition of medically necessary is in the Legal Definitions section of your member handbook. For more information on Covered Services and Exclusions, go to http://www.tn.gov/tenncare/mem-covered.shtml .
PCP stands for primary care provider. It is a health care provider who sees people that have common medical problems. This person is usually a doctor, but may be a physician assistant or a nurse practitioner. The job of your primary care provider includes:
If you already have a PCP other than the one listed on your card and he/she accepts your insurance, you can continue to see that provider. You can call Customer Service so they can update the PCP and send you a new card. BlueCare members call 1-800-468-9698. TennCareSelect members call 1-800-263-5479.
No. All claims must be filed by the provider.
Prior authorizations help you by ensuring nurses and doctors review the medical care you receive. They work to make sure that you get the most appropriate and cost-effective care.
No. Any services that require authorization must be requested from the servicing provider.
Your provider should let you know if the service is something that requires prior authorization. If the provider is unsure, they can call Customer Service.
See the following link for help understanding your ID card: BlueCare Tennessee ID Card Carrier
You may order a replacement ID card by calling BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service 1-800-263-5479. Your card will be sent to you within 2 weeks.
When you choose a PCP, we will send you a new ID card.
You will receive a separate ID card for your prescription benefits. If you haven't received your pharmacy card, you can call Magellan at 1-888-816-1680 or 1-800-254-7568 for the Spanish line. If you are eligible for vision and dental, you will use your medical ID card.
You would need to contact Tennessee Health Connection at 1-855-259-0701 (Toll-free, Monday – Saturday, 7 a.m. – 7 p.m. CT) to ask if that would affect your BlueCare.
Anytime other insurance is involved it would be primary over BlueCare or TennCareSelect. We are the payor of last resort.
Always give your doctor both insurance cards.
When the Bureau of TennCare tells us that you have chosen BlueCare/TennCareSelect, we will assign a provider located closest to you. The name of your primary care provider (PCP) is located on the BlueCare/TennCareSelect ID card. If you do not have your BlueCare/TennCareSelect ID card, or you would like to change your PCP you can call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479 for help.
Are you seeing your assigned Primary Care Provider (PCP)?
If not, you can call Customer Service to request a PCP change.
BlueCare members call 1-800-468-9698
TennCareSelect members call 1-800-263-5479
Find your assigned PCP’s name on your Member ID Card.
We all know how important it is for Primary Care Providers (PCP) to help with your health needs. BlueCare Tennessee encourages its members to make more informed health care choices. Coordinated care starts with your PCP.
Know your Assignment. You are assigned to a Primary Care Provider (PCP). Find your assigned PCP’s name on your Member ID Card. Your children are also assigned to a Primary Care Provider. At BlueCare Tennessee, we do well by helping you make good decisions about your child’s health care. One very big decision is your child’s Primary Care Provider. A PCP knows your child’s health history and can help him or her get needed care.
Continue to Build the relationship between you and your assigned doctor. For consistent health care, see your assigned PCP.
Learn to Communicate with your health care providers. It is important.
You may change your PCP as often as you need; the changes are effective immediately.
To find a new PCP go to the find a doctor section or you can call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479.
If you need help finding a new PCP, call us at BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479. We'll work with you to find a new PCP who is taking new patients.
We will send you a letter asking you to find a new PCP. To find a new PCP in the BlueCare or TennCareSelect network go to the find a doctor section . Or BlueCare members can call 1-800-468-9698. TennCareSelect members can call 1-800-263-5479. When you call the new PCP make sure he or she is in the BlueCare or TennCareSelect provider network and is taking new patients. Once you find the new PCP you will need to fill out the PCP Change Request form from the member handbook and mail it back to us. Or you can call us at Customer Service to tell us the name of your new PCP. BlueCare members can call 1-800-468-9698. TennCareSelect members can call 1-800-263-5479. If you do not find a new PCP, we will find one for you so you can keep getting your care.
If the member is under the age of 21:
For members age 21 or over:
Yes, Vision tests are included in the TennCare Kids checkup.
TennCare Kids is a program for BlueCare and TennCareSelect members under age 21. It provides free well care checkups. The program also provides care for medical, dental, speech, hearing, vision and behavioral health problems found at checkups. TennCare Kids helps make sure babies, children and teens get the care they need to be and stay healthy. All children and teens need regular checkups.
Children are required to have checkups in order to play in sports. The sports evaluations tend to be risk based, looking for potential injuries. No standard exists at this time to determine what should be included in the sports physical. These types of evaluations should not be considered substitutes for periodic medical screenings.
A well care checkup includes a complete physical examination including assessing your child physically, behaviorally, developmentally and emotionally. Well child visits can also help in the fight against preventable illness.
Early Periodic Screening, Diagnosis and Treatment (EPSDT) is a program of checkups and health care services for children from birth to age 21 to detect and treat health problems. The checkups are FREE for TennCare members.
We have provided a quick reference guide to help you keep track of your child's EPSDT schedule. The guide is located here.
Call your health care provider to make the EPSDT appointment. If you need more information, call the BlueCare Customer Service 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479.
The Member Handbook provides a listing of services that are non-covered services. Please review your member handbook for the detailed list. Or you may call our BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479 for a full list.
All babies born in U.S. hospitals must be tested for PKU. TennCare will pay for your baby’s PKU test.
Without early treatment, PKU can cause brain damage and other problems.
TennCare pays for PKU treatment, including licensed medical services and special formulas to feed babies.
National Institutes of Health – http://www.nlm.nih.gov/medlineplus/phenylketonuria.html
Genetics Home Reference – www.ghr.nlm.nih.gov/condition/phenylketonuria
When medically necessary, TennCare provides coverage for:
Also, many kinds of insulin and oral medicines for diabetes are on the Auto Exemption List (formerly called the pharmacy “short-list”). That means they do not count against your monthly drug limit. Too see the list:
Or you can call the Tennessee Health Connection to get this list. The number is 1-855-259-0701.
If you have any problems getting your supplies covered by TennCare, call Customer Service. The number is on the back of your member ID card.
BlueCare Tennessee knows you count on us for your incontinence supplies. Beginning August 1, 2015, you will receive all incontinence supplies from Medline Industries*. They are not a new provider for BlueCare Tennessee. Many of our members already use Medline for other medical needs.
Please have your doctor fax your prescriptions to Medline at 1-866-557-2737 before August 1, 2015.
Medline Customer Service will call soon to confirm your address and prescription. During this transition period, Medline will work with your current providers to make sure you have what you need. Medline will ship products directly to your home each month.
In the future, Medline will check in with you every month.
Call us with additional questions:
Before calling, it will be helpful to have the following information ready:
You can call the provider who is billing you for the services or you can call BlueCare Customer Service 1-800-468-9698 or TennCareSelect Customer Service 1-800-263-5479.
Yes, you will need to log into BlueAccess from our website. BlueAccess lets you view information securely online just as it appears to our Customer Service system. If you have not used BlueAccess you will need to register before you begin at https://www.bcbst.com/secure/register/default.do?reg=MEMV
Once you have registered you will be able to review your information 24 hours a day, 7 days a week as well as use your mobile device by typing bcbst.com on your mobile device.
Anytime you move, you must tell TennCare about your new address. TennCare sends you important information about your TennCare coverage and benefits in the mail. If they don't have your current address, you may lose your TennCare. Call Tennessee Health Connection at 1-855-259-0701 (Toll-free, Monday – Saturday, 7 a.m. – 7 p.m. CT) with your new address.
If you get SSI checks from the Social Security Administration (SSA) you must call your local SSA and give them your new address.
After you call Tennessee Health Connection at 1-855-259-0701 (Toll-free, Monday – Saturday, 7 a.m. – 7 p.m. CT), call BlueCare Customer Service 1-800-468-9698 or TennCareSelect Customer Service 1-800-263-5479 to tell us your new address.
If you are not happy with the care you are getting call our Customer Service. BlueCare members call 1-800-468-9698. TennCareSelect members call 1-800-263-5479. Please tell us you need to make a complaint. Nothing bad will happen if you make a complaint. It is important to let us know so we can ensure you get the best care possible.
Subrogation is the legal process that BlueCare or TennCareSelect can look to recover the amount of payment that another party was legally responsible to pay.
Subrogation allows BlueCare or TennCareSelect to recover health care payments when a third party may be at fault or workers compensation should be paying the bill. We ensure the correct payer pays for any medical expenses that result from an accident or work related injury or illness. Situations when someone else may be the primary payer may include the following:
Our members will receive a questionnaire when BlueCare or TennCareSelect receives and processes a claim that includes a diagnosis that requires reviewing for possible subrogation or workers' compensation involvement. Please complete the form and return as soon as possible. You may send by the fax number provided in the questionnaire or by the postage paid envelope provided.
You will need to complete the questionnaire but you can mark "NO" to the first question and tell us the fall occurred on your property.
Sometimes when you are in an accident, there is someone else who should pay for your health care. This could be a car accident or an accident at work. You must let us know who should pay for your health care if you are in an accident or injured at work. Call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479.
Call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479 first. If you are still having problems, you do have the right to file an appeal. To file an appeal, call TennCare Solutions at 1-800-878-3192. They can help you with your problem OR help you file an appeal.
You have the right to appeal if:
You only have 30 days to appeal after you find out that there is a problem.
Someone who has the legal right to act for you can also file an appeal for you. Usually, your appeal is decided within 90 days after you file it.
If you have an emergency, your appeal can be decided sooner, usually within 31 days (but sometimes up to 45 days).
An emergency means if you don't get the care sooner than 90 days:
If you think you have an emergency, you can ask TennCare for an emergency appeal. Your appeal may go faster if your doctor signs your appeal saying that it is an emergency. What if your doctor doesn't sign your appeal, but you ask for an emergency appeal? TennCare will ask your doctor if your appeal is an emergency. If your doctor says it's not an emergency, TennCare will decide your appeal within 90 days.
TennCare members are eligible for transportation for medical/behavioral appointments and pharmacy trips under the following circumstances:
Southeastrans, Inc. (SETI)** provides for non-emergency transportation to BlueCare and TennCareSelect members. You may contact Southeastrans at the following:
For BlueCare Members:
East Grand Region 1-866-473-7563
Middle Grand Region 1-866-570-9445
West Grand Region 1-866-473-7564
For TennCareSelect Members:
This is a free call. Phone lines are open 24-hours-a-day, 365-days a-year. We ask that you call to schedule your trip 72 hours in advance.
**Southeastrans provides transportation services for BlueCare and TennCareSelect members. Southeastrans is an independent company that does not provide BlueCross BlueShield of Tennessee branded products and services.
To schedule local transportation, you can call Southeastrans, Inc. (SETI) directly. If you know the trip is over 90 miles you will need to call BlueCare Customer Service 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479 directly.
You will need the following information ready to provide to the representative scheduling your transportation:
Please call Southeastrans, Inc. (SETI)** as soon as possible to cancel or reschedule your transportation:
For BlueCare Members:
East Grand Region 1-866-473-7563
Middle Grand Region 1-866-570-9445
West Grand Region 1-866-473-7564
For TennCareSelect Members:
* Southeastrans provides transportation services for BlueCare and TennCareSelect members. Southeastrans is an independent company that does not provide BlueCross BlueShield of Tennessee branded products and services.
TennCare CHOICES in Long-Term Care (or "CHOICES" for short) is TennCare's program for long-term care services. Long-term care includes help doing everyday activities that you may no longer be able to do for yourself as you grow older, or if you have a disability—like bathing, dressing, getting around your home, preparing meals, or doing household chores. Long-term care services include care in a nursing home. Long-term care also includes care in your own home or in the community that may keep you from having to go to a nursing home for as long as possible. These are called Home and Community Based Services or HCBS. More information about CHOICES is found in your CHOICES section of the member handbook.
If you think you need long-term services and supports, call us at 1-800-468-9698.
We may use a short screening that will be done over the phone to help decide if you may qualify for CHOICES. If the screening shows that you don't appear to qualify for CHOICES, you'll get a letter that says how you can finish applying for CHOICES. If the screening shows that you might qualify for CHOICES, or if we don't conduct a screening over the phone, we will send a Care Coordinator to your home to do an assessment. The purpose of the in-home assessment is to help you apply for CHOICES. It's also to find out:
This does not mean that you will receive services up to the cost of nursing home care. CHOICES won't pay for more services than you must have to safely meet your needs at home. And, CHOICES only pays for services to meet long-term services and supports needs that can't be met in other ways. To see if you qualify to enroll in CHOICES, call us at 1-800-468-9698.
CHOICES Group 1 is for people of all ages who receive nursing home care.
To be in CHOICES Group 1, you must:
CHOICES Group 2 is for certain people who receive home care instead of nursing home care.
To be in CHOICES Group 2, you must:
To be in CHOICES Group 3, you must:
For more information see the Member Handbook or call our Customer Service line at BlueCare Customer Service 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479.
In CHOICES, BlueCare is responsible for managing all of your physical health, mental health and long-term services and supports needs, and the services that you receive to address these needs. These functions are carried out by a Care Coordinator. We will assign you a Care Coordinator when you enroll in CHOICES. Your Care Coordinator will play a very important role. Your Care Coordinator is your primary contact person and is the first person that you should go to if you have any questions about your services. For a complete list of services please review your Member Handbook.
If you're in CHOICES Group 2 or CHOICES Group 3, you can ask TennCare to review your needs assessment or plan of care if you have concerns and think you're not getting the services you need. TennCare will review the assessment or plan of care and the information gathered by your Care Coordinator. If TennCare thinks you're right, they'll work with us to fix the problem. If TennCare thinks you are getting the services you need, they'll send you a letter that says why. To request an objective review of your needs assessment and plan of care, you must submit a written request to:
TennCare Division of Long Term
Services and Supports
c/o CHOICES Review
310 Great Circle Rd.
Nashville, TN 37243
Keep a copy of your request. Write down the date that you sent it to TennCare or fax your request to 1-615-532-9140. Keep the page that shows your fax went through.