Programs, Services and FAQs

TennCare Kids / EPSDT

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.

TennCare Kids Quick Reference Guide

Who is Eligible?

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.

Medical Record Documentation Requirements

Each TennCare Kids encounter should include:

  • All seven components of a TennCare Kids examination.
  • All appointments for other health care, including dental care.
  • The reason for not performing any component of the examination.
  • Any service declined by the member.

Seven TennCare Kids Screening Components

  1. Comprehensive health and developmental history;
  2. Comprehensive unclothed physical examination including measurements
  3. Appropriate immunizations;
  4. Appropriate vision and hearing testing;
  5. Appropriate laboratory tests;
  6. Dental screening services furnished by direct referral to a dentist for children no later than 3 years of age and should be referred earlier as needed (as early as 6 to 12 months in accordance with the American Academy of Pediatric Dentistry (AAPD) guidelines) and as otherwise appropriate and;
  7. Health education/anticipatory guidance.

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.

Interperiodic Screenings

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.

Coordination of Care

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.

Transportation

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

TennCare Kids Tool Kit

Periodicity Schedule

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.

 Immunizations

Lead Screening

Pediatric Symptom Checklist

Tuberculosis

Vaccines for Children (VFC) Program

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

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.

CaringStart Maternity Management Program

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 Prior Authorization

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.

High Tech Imaging Prior Authorization List

Durable Medical Equipment:

No Authorization required for Durable Medical Equipment (DME) Items

Pharmacy

Diagnostic Lab Exclusions List

Quest Diagnostic for Lab Services Effective 04/01/2017 and After

Frequently Asked Questions (FAQs)

Why is it important to promptly submit requested medical records to BlueCare Tennessee?

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.

Why are providers required to have a Tennessee Medicaid number?

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.

Does the requirement to obtain a Tennessee Medicaid number apply to only in-state Providers?

The requirement applies to any in-state or out-of-state provider who provides services to a TennCare enrollee.

How does a provider obtain a Tennessee Medicaid number?

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.

What will happen if a claim for a BlueCare Tennessee member is filed without a Tennessee Medicaid number?

Claims filed without the provider’s Tennessee Medicaid number will be denied.

Are vision and dental services covered?

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.

How does a Provider request changes to their provider record information?

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.

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