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.
BlueCare Tennessee’s prospective review process allows providers to submit claims and medical records for review of a medical emergency prior to payment of a screening fee when the diagnosis code filed is not on the Medical Emergency Diagnosis code list. 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.
For complete information about BlueCare Tennessee’s policies, please see the Emergency Services section of the Provider Administration Manual.
For information about emergency medical services coverage for illegal and ineligible aliens, please visit the State of Tennessee website.