BlueCare Tennessee and CoverKids Maternity Care Program

We’re dedicated to partnering with you for the health of your patients. Through our Maternity Care Program, BlueCare Tennessee and CoverKids obstetric providers can earn payments on top of their regular reimbursements for maternity care.

As part of the program, you can also help your patients covered by BlueCare Tennessee receive up to $100 towards the purchase of baby supplies by simply signing a form. (The program does NOT include gift cards for CoverKids members.)

Getting paid is easy. The following chart outlines the process for you and your patients.

BlueCare Tennessee and CoverKids Billing and Reimbursement Guidelines
These are the guidelines for you to receive the extra payments; they’re the same for both lines of business

Type of Visit

Prenatal

Postpartum

Timeframe for Visit

During the first trimester of pregnancy or within 42 days of BlueCare Tennessee or CoverKids enrollment

Within 21 to 56 days of delivery

Steps to Receive Payment

Bill the visit using category II code 0500F and, please remember to:

  • Include the appropriate Evaluation & Management (E&M) Code (99201-99205 or 99211-99215) confirming pregnancy.*
  • Include the date of the last menstrual period in form locator 14 or Loop 2300 with Qualifier 484.
  • Submit the Maternity Care Management Notification Form through Availity or fax to (423) 854-6033.
  • Bill the $10 fee associated with this code.

Bill the visit using category II code 0503F and, please remember to:

  • Include the postpartum code 59430.
  • Include the Delivery Date in form locator 14 or Loop 2300 with Qualifier 431.
  • Bill the $10 fee associated with this code.

Reimbursement

$10 per patient

$10 per patient

How To Help Your BlueCare Tennessee Patients Receive Gift Cards
(Please note CoverKids members are NOT eligible for gift cards.)

Type of Visit

Prenatal

Postpartum

Steps to Help Your Patient to Receive Gift Card Payment

Gift Card Amount

$50

$50


*In situations where the provider billing 0500F didn’t perform a separate visit to confirm the pregnancy and the prenatal profile was started on the first visit, the provider may bill the appropriate E&M codes at $0.00 charges. This step will show there was not a separate visit for confirmation only prior to beginning the prenatal profile and that the provider is simply following the rules for billing the code.

Certain billing scenarios listed above may be considered non-standard billing. However, Blue Care Tennessee will allow these billing scenarios in order to compensate providers for the timely submission of the required information.

All other billing and processing guidelines apply, including but not limited to, prior authorization requirements, coordination of benefits and timely filing. Additionally, all claims submitted to BlueCare Tennessee are subject to retrospective claims review and possible recovery.

BlueCare Tennessee now reimburses separately for procedure code 58300 (insertion of intrauterine device) when performed at the time of the delivery. This means the reimbursement for 58300 is no longer bundled with the payment for delivery.


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Types of Coverage

Want to learn more about TennCareSM, CoverKids or the other programs we offer? Find helpful details, including how to apply.

+ Find Out About Our Programs
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Are You Expecting?

Take healthy steps for you and your baby, and you can earn some extra $.

+ Find Out How to Earn Gift Cards