Emergency Services

BlueCare Tennessee shall pay for any emergency screening examination services conducted to determine whether an emergency physical/behavioral health condition exists and for all emergency services that are medically necessary until the member is stabilized.

Refer to the attached BlueCare Tennessee Policy for additional information: Emergency Services Reimbursement Guidelines - Policy 10.22.15

When the diagnosis code filed is not on the Medical Emergency Diagnosis code list, BlueCare Tennessee has implemented a prospective review process. This process will allow providers to have their claims and medical records reviewed for medical emergency determination prior to the screening fee being paid.  Providers may attach the complete emergency room medical record to the claim upon initial submission. The claim and record will be suspended for clinical review.

Refer to the BlueCare Tennessee Provider Administration Manual for billing guidelines.

Emergency Medical Services for Illegal and Ineligible Aliens

Federal law requires that state Medicaid programs cover emergency medical services for illegal and ineligible aliens, when these individuals otherwise meet the financial criteria for Medicaid.