BlueCare Tennessee Providers

Last Updated on January 21, 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,

Now that we’ve moved into a new year, we want to reinforce how grateful we are for our relationship with you and the care you provide to our members. We realize our struggles from 2020 aren’t over yet. But we’re also encouraged by the recent availability of COVID-19 vaccines and the ongoing rollout across our state.

As governmental and operational guidelines continue to shift, we understand that you and your patients have a lot of questions. We’re doing our best to answer them in our FAQs, so please continue to visit this website for important updates. You’ll find information about our COVID-19 policies, as well as the latest information about vaccine policies and procedures.

Also, please continue to check our payer space at Availity.com for updates throughout this state of emergency.

Sincerely,

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

We’re Here To Support You

With surges of COVID-19 cases, we want to help you in continuing to provide care for our members. This isn’t a comprehensive list of BlueCare Tennessee actions we’ve taken to help (such as encouraging our members to schedule telehealth visits and the community-serving efforts of our foundation), but rather items we know are relevant to hospital operations:

  • We’ve waived the authorization requirement for initial post-acute care reviews (skilled nursing facility, rehab and LTACH) 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.
  • We’re 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 added flu testing and COVID-19 tests to our 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.
  • We’re suspending all medical record requests and audits for inpatient and outpatient facility claims, and postponing manual collection of medical records for HEDIS and in-office reviews for Quality and Value-based programs, through March 31, 2021. After that date, if hospitals request 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.
  • We’re 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.
  • We’re waiving readmission penalties during the PHE by paying the readmission as a separate claim. Unfortunately, CMS didn’t issue guidance to allow the same flexibility on Medicare Advantage.

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

 

Your Health

 

Protecting Yourself and Others

 

BlueCross Working for You