The role of the Primary Care Provider (PCP) hasn’t changed throughout the years. The PCP supervises a person’s health care through many stages of their lives.
The goal of the myBLUEPCP program is to strengthen the doctor-patient relationship. In this program, members are only allowed to see their assigned PCP or an affiliated, covering PCP who’s in our network. No other PCP is reimbursed for providing services to them. Providers should offer BlueCare Tennessee members with care built to meet specific quality-of-care metrics in their practice.
It’s our intention to provide all practices with a solid framework to lessen claim denials by using Availity®, our secure provider portal. In Availity, providers can view their current member rosters to ensure patients requesting services are assigned to them. Members can change their PCP assignment at any time.
This program has been in effect since Aug. 1, 2015, for BlueCareSM and TennCareSelect members. You can view a copy of the communication we mailed on July 20, 2015: PCP Requirement Effective with date of service 8/1/15. The program has been in effect for CoverKids members since Jan. 1, 2021.
We’ve also prepared FAQs about this program here: myBLUEPCP FAQs.
Members excluded from the requirements of this program include:
- Retro-eligible members.
- Dual-eligible members.
- Babies who are 90 days old or younger.
Are you seeing your assigned members?
As a PCP caring for BlueCare, TennCareSelect or CoverKids members, it’s your responsibility to verify that any member you see is assigned to the patient listing for you, your covering provider or another participating PCP in your group. Please be sure to check the member’s ID card or check your member roster on Availity to confirm assignment.
Our members are allowed to change their PCP assignment at any time. Your office can submit the change request to us, or the member can call us.
The objectives of the myBLUEPCP program are in line with the Patient-Centered Medical Home Model, which aims to strengthen the doctor-patient relationship. We’ll notify PCPs if we see they’ve provided services to a high number of members who aren’t assigned to them or their provider group. We’ll accomplish this by monitoring claims data.
Up-to-date listings of assigned members are available to registered PCPs in Availity and are also accessible on mobile devices.
It’s important for your office staff to check the member’s ID card and the member roster on Availity to confirm assignment.
For PCPs with a group affiliation:
- All participating PCPs who are in the same provider group and have the same tax ID are loaded as covering for each other.
- All PCPs who have the same tax ID but are in different groups can be loaded as covering for each other based on information provided from your office.
For PCPs without a group affiliation:
- If you’re not affiliated with a group, we’ll manually load the covering provider information we receive from your office.
Help ensure covering logic is correct:
- Call Provider Service at 1-800-924-7141, option 1.
- Fax your covering provider listing on business letterhead to (423) 535-3066 or (423) 535-5808.
- Mail your covering provider listing on business letterhead to BlueCare Tennessee 1 Cameron Hill Circle - Attention: Provider Network Enrollment 2.4 Chattanooga, TN 37402-0001
Remember the ABCs to Wellness
We all know how important it is for PCPs to help coordinate our member’s health care needs. We encourage our members to make more informed health care choices and direct them to receive coordinated care, which starts with their PCP.
Know your member Assignment list. It’s your responsibility to verify that any member you see is assigned to your member roster or another participating PCP in your group. Be sure to check the member’s ID card or your member roster in Availity to confirm assignment.
Continue to Build the relationship you have with your assigned members. You have the opportunity to supervise a person’s health care through many stages of their lives.
Communicate with your BlueCare Tennessee members. Engage in conversations with your members using plain language. The average reading level of your patients is around sixth grade. Most patients won’t tell you they don’t understand. Using plain language helps your patients understand their treatment plan and how to take their prescriptions properly. This is also important for your patients who don’t speak English as their primary language.
Making PCP Changes
Our members can change their PCP assignment any time. Providers can help their patients change their PCP by:
- Using the BlueCare PCP Change application in Availity. The application makes changes in real time, and your patients receive an updated digital and hard copy of their Member ID card automatically. For more information, please see the BlueCare Tennessee and CoverKids PCP Change Maintenance Application Quick Reference Guide located in the Resources section of Availity Payer Spaces.
- Calling the applicable Customer Service line while the member is in the office and allowing them to speak to Customer Service to request the PCP Change.
- Faxing the completed provider PCP Change Request form to 1-888-261-9025
- Emailing PCP change requests to: FAX_pcp@bcbst.com.
Your patients can also initiate the request by:
- Calling customer service: BlueCare: 1-800-468-9698, TennCareSelect: 1-800-263-5479, CoverKids: 1-800-924-7141.
- Faxing the completed member PCP Change Request form to 1-888-261-9025. The form can be found in their member handbook.
- Printing a temporary ID card from their BlueAccessSM account at bluecare.bcbst.com