Programs, Services and FAQs

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 Division 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 Division 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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