The role of the Primary Care Provider (PCP) has not 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 will only be allowed to see their assigned PCP or an affiliated, covering & participating PCP. No other PCP will be reimbursed for providing services to them effective 8/01/15. Providers should offer BlueCare Tennessee members with care built to meet specific quality of care metrics in their practice.
It is our intention to provide all practices with a solid framework to lessen claim denials through the use of our up-to-date BlueAccess portal. Here current Member Rosters will be accessed to ensure the patient is actually assigned to the PCP from whom they are requesting services. The member can have their PCP assignment changed at any time.
Communication mailed on 7/20/15: PCP Requirement Effective with date of service 8/1/15
FAQs from the provider community: myBLUEPCP FAQs
BlueCare members excluded from the requirements of this program are:
- Retro-eligible members
- Dual-eligible members
- Babies who are <=90 days old
Are you seeing your assigned members?
As a BlueCare/ TennCareSelectSM PCP, it is your responsibility to verify that any member you see is assigned to your 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 the patient listings on BlueAccess to confirm assignment.
The member is 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. BlueCare Tennessee is also committed to notifying PCPs when it is determined they have provided services to a high number of members who are not assigned to them or to their provider group. This will be accomplished through monitoring and analyzing claims data.
Up-to-date listings of assigned members are available to registered PCPs through BlueAccess and are also accessible on mobile devices.
It is important for your office staff to check the member’s ID card and the patient listings on BlueAccess to confirm assignment. Your secure account can be accessed from bluecare.bcbst.com. With our BlueAccess Member Roster, your office is able to:
- Sort the listing
- Choose more than one line of business (for example, choose BlueCare & TennCareSelect)
- Export data to Excel or PDF
- View several data elements such as the member’s phone number and plan ID, along with effective and term dates of PCP assignment
Note: Effective 3/15/16 the member roster is available in real-time and reflects any changes made when the report is generated.
For PCPs with group affiliation:
- All participating PCPs within the same provider group will be loaded as covering for each other.
- All PCPs under the same tax ID but in different groups, can be loaded as covering for each other based on information provided from your office.
For PCPs without group affiliation:
- Covering provider information can be loaded for providers without group affiliation based on information provided by your office.
How to help ensure Covering Logic is correct:
- Call Provider Services at 1-800-924-7141, option 1
- Fax your covering provider listing on business letterhead to (423) 535-3066 & (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 ABC’s to Wellness
We all know how important it is for Primary Care Providers (PCP) to help coordinate our member’s health care needs. BlueCare Tennessee encourages its members to make more informed health care choices, while directing them to receive coordinated care which starts with their PCP.
Know your member Assignment list. As a BlueCare/TennCareSelectSM PCP, it is your responsibility to verify that any member you see is assigned to your patient listing or another participating PCP in your group. Be sure to check the member’s ID card or check the patient listings on BlueAccess to confirm assignment.
Continue to Build the relationship between you and 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 will not tell you they do not understand. Using plain language helps your patients to understand their treatment plan and know how to take their prescriptions properly. This is also important for your patients who do not speak English as their primary language.
PCP Change form
Members are allowed to change their PCP assignment at any time by initiating a PCP change request. The member can:
- Call customer service: BlueCare: 1-800-468-9698 TennCareSelect: 1-800-263-5479
- Fax the completed PCP Change form to 1-888-261-9025. The form can be found in their member handbook
- Print a temporary ID card from their BlueAccess secure account at bluecare.bcbst.com
The provider can:
- Call the Customer Service line while the member is in office and allowing the member to speak to Customer Service to request the PCP Change
- Fax the completed PCP Change form to 1-888-261-9025
Providers can submit changes to their member rosters by:
- E-mailing PCP change requests via e-mail mailbox: IO-BluecarePCP_GM@BCBST.com