Thousands of kids (ages 20 and younger) from low-income homes in Tennessee miss their annual well-care checkups and that number increases every year. Statewide, about three of every 10 kids enrolled in BlueCare Tennessee do not get the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) they need. We’re working to reverse that trend and we’re asking for your help.
Your patients (ages 20 and younger) covered by BlueCare Tennessee are eligible for well-care visits, including members under age 21 who need prenatal care services from their obstetricians.
Each TennCare Kids encounter should include:
Appointments must be made for other necessary health care, diagnostic services, treatment and other measures to correct, ameliorate, or prevent from worsening defects and mental illnesses and conditions discovered during the screening services, regardless of whether the required services are covered under by the member’s behavioral health organization or managed care organization. When screening reveals the need for other health care and the practitioner is unable to obtain an appointment, he or she must notify BlueCare or TennCareSelect Provider Service for assistance with appointment scheduling.
Parents, teachers or others may notice a health problem with a child that might need a screening outside of a well-check visit. These interperiodic screenings could show that a child has a condition that needs care. Interperiodic screenings are covered by BlueCare Tennessee and do not require prior authorization.
Please share the details of any TennCare Kids services or preventive care with the primary care practitioner (PCP) shown on the member’s ID card to ensure the child’s PCP has a complete record of health for the patient. To ensure care coordination, PCPs should refer children enrolled in an Individual Education Program (IEP) and/or Individual Family Service Plan (IFSP) to our Care Management Department by calling 1-888-416-3025 or faxing information to 1-800-421-2885.
If you have a patient who is under age 21 and does not have a way to get to an appointment for TennCare Kids services, transportation is available by contacting Southeastrans at the following numbers:
BlueCare East Region – 1-866-473-7563
BlueCare Middle Region – 1-866-473-7564
BlueCare West Region – 1-866-473-7564
TennCareSelect – 1-866-473-7565
CHOICES/ECF CHOICES – 1-888-747-8955
SelectCommunity – 1-800-292-8196
Your patients covered by BlueCare Tennessee are eligible for well-care visits on the same schedule recommended by the American Academy of Pediatrics (AAP). A complete description of EPSDT requirements for screening, documentation and billing are available in the TennCare Kids section of the provider administration manual.
Your practice can receive payments for the administration of vaccines under the federal VFC program by registering with the Tennessee Immunization Information System (TennIIS). TennIIS is a statewide system managed by the Tennessee Department of Health to help ensure Tennesseans of all ages are properly immunized. The program allows health care providers, pharmacists, schools and childcare organizations to access and update vaccination records.
To learn more about TennIIS and VFC programs, please visit the TennIIS website.
If you are interested in enrolling in the VFC Program for the first time or would like to request a Starter Kit, please contact the VFC Enrollment team directly at VFC.Enrollment@tn.gov
CareSmart Clinical Care Management Programs partner with you to improve the health and quality of life for your patients with chronic disease and illness. The programs emphasize the importance of primary care provider collaboration and involvement.
The CaringStart Maternity Management program works with you to improve the health and birth outcomes of your pregnant patients. For more information visit our Maternity Care section
Advanced imaging includes many diagnostic tools like CT, MRA, MRI and PET that require prior authorization for your patients covered by BlueCare. To request prior authorization, please contact eviCore – by phone 1-888-693-3211 or by fax 1-888-693-3210.
In-network providers caring for TennCareSelect, CHOICES or ECF CHOICES members are not required to have prior authorization. If you’re not an in-network provider seeking prior authorization, please contact our Utilization Management department at 1-800-711-4104.
Your office may receive requests for medical records for a variety of reasons including audits and medical necessity reviews. Please make sure to handle these requests as a priority. Failure to submit the records in a timely manner may result in a payment being denied or recovered. The submission of requested records is not eligible for reimbursement.
The Bureau of TennCare requires all providers and facilities caring for TennCare enrollees to obtain and have on file a Tennessee Medicaid number before claims can be processed for payment.
The requirement applies to any in-state or out-of-state provider who provides services to a TennCare enrollee.
Providers may obtain a Tennessee Medicaid number by calling the Medicaid/TennCare Provider Enrollment Unit at 1-800-342-3145, by visiting the Provider page of the company Web site, bcbst.com, or the Bureau of TennCare's Web site.
Claims filed without the provider’s Tennessee Medicaid number will be denied.
Routine vision and dental services are covered for members under the age of 21. Vision services are covered for members over 21 if they are due to certain illnesses or accidental injuries. BlueCare and TennCareSelect will not pay for eyeglasses, contact lenses or examinations for prescribing or fitting them for members over the age of 21 except for the first pair of cataract glasses or contact lenses following cataract surgery.
Providers can request a change to their information by completing a Provider Change in Information Change Form. Instructions for return are at the bottom of the form.