FAQs

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

How do I know if I can get TennCare?

In order to be eligible for TennCare as a new applicant, you must first qualify for TennCare Medicaid. To find out if you qualify:

They told me I didn't qualify for BlueCare/TennCareSelect. Can I appeal this?

Yes. There are 2 ways to appeal if you were denied for BlueCare/TennCare Select:

  1. Appeal by phone by calling the Family Assistance Service Center at 1-866-311-4287.
  2. OR, appeal in writing. You can get an appeal page from DHS. Or, you can write your appeal on plain paper. If you write your appeal on plain paper, be sure you include:
    • Your full name (first name, middle initial, last name)
    • Your Social Security Number
    • The names of anyone else in your household with the same problem
    • Your daytime phone number and the best time to call
    • The specific mistake you think we made
    • Any proof that shows why you think we made that mistake

Mail your appeal to this address:
Tennessee Department of Human Services
Division of Appeals and Hearings
P.O. Box 198996
Nashville, TN 37219-8996

New Member

When will I get my BlueCare/TennCareSelect ID card?

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.

There is a co-pay amount on my card and I disagree with how much I have to pay. What can I
do to change the amount of co-pays?

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:

  1. Your name including your first, middle and last name
  2. Your Social Security Number
  3. Include the names of anyone else in your household with the same problem
  4. Include a daytime phone number and what time is the best to call
  5. Explain the mistake you think was made
  6. Include any proof that shows why you think the mistake was made

Mail the appeal to:
Tennessee Department of Human Services
Division of Appeals and Hearings
P.O. Box 198996
Nashville, TN 37219-8996

How do I know what medical services are covered?

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 off-site link.

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 off-site link.

There is a PCP listed on my new card. What is a PCP and is that the only provider that I am
allowed to see?

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:

  • Provide preventive care and teach healthy life choices
  • Find and treat common medical conditions
  • Direct you to the best place for care
  • Refer you to medical specialist when necessary

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.

Can I file my own claim?

No. All claims must be filed by the provider.

Authorizations

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.

Can I request an authorization for myself?

No. Any services that require authorization must be requested from the servicing provider.

How do I know if something requires an authorization?

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.

ID Cards

See the following link for help understanding your ID card: BlueCare Tennessee ID Card Carrier

How can I get a replacement ID card?

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.

If I change my primary care provider will I get a new ID card?

When you choose a PCP, we will send you a new ID card.

Will I get a separate ID card for vision, dental, and pharmacy?

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.

Third Party Liability/Coordination of Benefits

I have BlueCare now. If I get insurance through my work, will I lose my BlueCare?

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.

I have another insurance and BlueCare. Which one is primary?

Anytime other insurance is involved it would be primary over BlueCare or TennCareSelect. We are the payor of last resort.

I have another insurance and TennCareSelect. Which card do I need to give my doctor?

Always give your doctor both insurance cards.

Primary Care Provider (PCP)

Who is my Primary Care Provider (PCP)?

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.

How often can I change my PCP?

You may change your PCP as often as you need; the changes are effective immediately.

How do I change my PCP?

To find a new PCP go to the find a doctor section off-site link or you can call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479.

  • Call the new PCP to make sure that he or she is in the BlueCare provider network. Ask if he or she is taking new patients.
  • If the new PCP is in our network and taking new patients, fill out the PCP Change Request in the "Health care papers you may need" section of your member handbook and mail it back to us.
  • Or you can call BlueCare Customer Service at 1-800-468-9698 or TennCareSelect Customer Service at 1-800-263-5479 to tell us the name of your new PCP.

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.

What happens if my PCP no longer accepts BlueCare or TennCareSelect?

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 off-site link. 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.

Vision and Dental

Are vision and dental services covered?

If the member is under the age of 21:

  • BlueCare/TennCareSelect covers routine vision and dental services for members under the age of 21.

For members age 21 or over:

  • Vision services are covered for members age 21 or over, if they are due to illness, accidental injury or medically necessary as determined by your PCP.
  • BlueCare/TennCareSelect will not pay for periodic evaluation, or screening of normal eyes and examinations for prescribing fitting or changing eyeglass and/or contact lenses for members over the age of 21 except for the first pair of cataract glasses or contact lens/lenses following cataract surgery.
  • Dental services for members over the age of 21 are not covered.

Are vision tests covered for my child?

Yes, Vision tests are included in the TENNderCARE checkup.

Services

What is TENNderCARE?

TENNderCare 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. TENNderCare helps make sure babies, children and teens get the care they need to be and stay healthy. All children and teens need regular checkups.

Is a sport physical the same as a well care checkup?

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.

What is EPSDT?

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.

How often does my child need an EPSDT checkup?

We have provided a quick reference guide to help you keep track of your child's EPSDT schedule. The guide is located here.

How do I make an appointment for the EPSDT?

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.

What is a non-covered service?

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.

General

Who do I call if I have a question about a bill I received?

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.

Can I see my benefits on-line?

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 off-site link

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.

What should I do if I move?

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.

What can I do if I have a problem or complaint?

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

I received a subrogation questionnaire in the mail. What is subrogation and why did I get this?

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:

  • Automobile Insurance
  • Medical Malpractice
  • Workers' Compensation
  • General Liability
  • Home Owners' Insurance
  • No-Fault Insurance

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.

If I fell in my home, do I need to complete the questionnaire mailed to me?

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.

I was involved in an auto accident. What should I do?

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.

Appeals

BlueCare/TennCareSelect denied, delayed, reduced, suspended, or terminated one of my services.
What should I do?

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.

When should I file for an appeal?

You have the right to appeal if:

  • TennCare says no when you or your doctors ask for health care.
  • Or, TennCare stops or changes your health care.
  • Or, you have to wait too long to get health care.
  • Or, you have health care bills you think TennCare should have paid for, but didn't.

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.

What if I can't wait 90 days to hear the decision about my appeal?

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:

  • You will be at risk of serious health problems OR you may die.
  • OR, it will cause serious problems with your heart, lungs, or other parts of your body.
  • OR, you will need to go into the hospital.

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.

Transportation

Does my insurance cover transportation?

TennCare members are eligible for transportation for medical/behavioral appointments and pharmacy trips under the following circumstances:

  • Member is eligible for TennCare on the date of the trip
  • The transport is for a covered TennCare service
  • The transport is to a participating provider
    NOTE: If an out-of-network authorization exists, the member can be transported. In addition, members with Medicare may see any provider that accepts Medicare assignment.

Who provides transportation for BlueCare and TennCareSelect?

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
West Grand Region 1-866-473-7564

For TennCareSelect Members:
Statewide 1-866-473-7565

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 trip72 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.

Who should I call if I need to schedule transportation?

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.

What do I need to have ready to call for transportation?

You will need the following information ready to provide to the representative scheduling your transportation:

  • Your name, phone number and extension
  • Your facility's name and address
  • The member's full name as it appears on his/her TennCare Member ID Card
  • The member's home address (including County)
  • The member's social security number
  • The member's TennCare ID number
  • The member's date of birth
  • The member's room number (for stretcher patients only)
  • An emergency contact person with phone number for the member
  • Name of contact person at the location to which the member is being transported
  • Type of service required: ambulatory, wheelchair or stretcher
  • Any special needs the member may have. This includes a mental or physical disability or the need for an escort.

I need to cancel my transportation, what do I do?

Please call Southeastrans as soon as possible to cancel or reschedule your transportation:

For BlueCare Members:
East Grand Region 1-866-473-7563
West Grand Region 1-866-473-7564

For TennCareSelect Members:
Statewide 1-866-473-7565

CHOICES

What is CHOICES?

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.

How do I apply for CHOICES?

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:

  • The kinds of help you need;
  • The kinds of care being provided by family members and other caregivers to help meet your needs;
  • And the gaps in care for which paid long-term services and supports may be needed.

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.

What long-term services and supports are covered in CHOICES?

CHOICES Group 1 is for people of all ages who receive nursing home care.

To be in CHOICES Group 1, you must:

  • Need the level of care provided in a nursing home;
  • And qualify for Medicaid long-term services and supports;
  • And receive nursing home services that TennCare pays for.

CHOICES Group 2 is for certain people who receive home care instead of nursing home care.

To be in CHOICES Group 2, you must:

  • Need the level of care provided in a nursing home;
  • AND qualify for Medicaid long-term services and supports because you receive SSI payments OR because you need and will receive home care services instead of nursing home care.
  • AND be an adult 65 years of age and older;
  • OR be an adult 21 years of age and older with a physical disability.

To be in CHOICES Group 3, you must:

  • Meet the "at risk" for nursing home level of care;
  • AND qualify for Medicaid long-term services and supports because you receive SSI payments OR because you need and will receive home care services to keep you from going into a nursing home.
  • AND be an adult 65 years of age and older;
  • OR be an adult 21 years of age and older with a physical disability.

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.

What is a Care Coordinator in CHOICES?

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.

What do I do if I don't think I am getting enough services?

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.