BlueCare Tennessee Providers

Last Updated on June 16, 2021
Please refer to this section for helpful information about treating BlueCare Tennessee members during the COVID-19 state of emergency.

A Message From Todd Ray (Please note updates are frequent)


Dear Valued Provider,

As more Tennesseans become vaccinated, we want you to know how much we appreciate the care you provide to our members. One of our highest priorities is to help you stay informed in a climate that changes quickly and sometimes drastically.

With that in mind, please continue to visit this site for updates about the vaccines and what we’re doing to help members and providers throughout the pandemic. We also encourage you to follow us @BCBST on Facebook, Twitter and Instagram, and @BlueCross BlueShield of Tennessee on LinkedIn. You’ll find helpful resources, including interviews with BlueCross leaders discussing the importance of getting the vaccine.

For information on state and federal guidelines, please continue to visit the State of Tennessee and CDC COVID-19 websites. You’ll find the links below.

We’re doing our best to address your concerns and those of your patients. But we know you may still have questions. If you need assistance, please reach out to your local Provider Network Manager.

We appreciate the dedication you’ve shown, especially during this difficult time.

Sincerely,

Todd Ray, Senior Vice President, Corporate Provider Network Management and Medicare Products

We’re Here To Support You

During surges in COVID-19, we took significant steps to remove barriers for members to receive care while streamlining certain necessary requirements for our providers, including:

  • BlueCare Tennessee has waived the authorization requirement for initial post-acute care reviews (skilled nursing facility, rehab and LTACH) until June 30, 2021, to support rapid placement and discharge of currently hospitalized patients who can be safely discharged to another setting. Notification is required within one business day of admission. Concurrent reviews for medical necessity will continue after the first week of admission.
  • BlueCare Tennessee is allowing flexibility to charge inpatient rates in the emergency department or other units where patients may need to be housed, based on intensity of service.
  • We’ve permanently added flu testing and COVID-19 tests to BlueCare's exclusive lab exception list.
  • If a hospital requests to extend appeals timeframes past 180 days, we’ll approve reasonable requests on a case-by-case basis.
  • BlueCare suspended all medical record requests and audits for inpatient and outpatient facility claims, and postponed manual collection of medical records for HEDIS and in-office reviews for Quality and Value-based programs, through March 31, 2021. Moving forward, if hospitals request an extension of these due to staffing shortages, overwhelmed hospital capacity or other factors, we’ll review on a case-by-case basis and make accommodations as appropriate.
  • BlueCare is paying for COVID testing prior to inpatient admission separately, even if within the 72-hour window where it would normally be included in the DRG.
  • BlueCare is permanently waiving readmission penalties for COVID-19 hospital stays, unless there’s evidence of an unsafe discharge.

As the strain on the system lessens, we’re putting necessary requirements back into effect. We’ll keep you updated on changes as they occur.

Important Provider Updates and Resources From Federal and State Governments

COVID-19 Emergency Disclaimer

During the COVID-19 emergency, we’ll continue to follow the COVID-19-related policies and processes listed in this section of the BCBSTupdates website. Many of our decisions are guided by federal and state mandates, which occur frequently, so we encourage you to refer to this site daily. Should we decide to make a non-mandated change to a policy or process listed in the provider Q&As during the COVID-19 emergency, we’ll post the update 30 days in advance on this site.


For BlueCare, TennCareSelect and CoverKids lines of business unless stated otherwise.


COVID-19 Vaccine

COVID-19 Testing and Treatment

COVID-19 Drive-Through Testing

COVID-19 Antibody Tests

Telehealth Coverage

Contracting, Credentialing and Enrollment

Operations

Procedural


CPT® is a registered trademark of the American Medical Association

Your Health

Protecting Yourself and Others

BlueCross Working for You