• Reinstatement of COVID-19 Post-Acute Placement Flexibility (Aug. 13, 2021)
• Expiration of COVID-19 Policies Regarding Hospital Administrative Flexibilities (June 9, 2021)
• TennCare Extends Most Hospital Admin Flexibilities for COVID-19 to June 30, 2021; Addresses Medical Record Requests, Recoupments & Audits (March 2, 2021)
• TennCare Extends Telehealth Coverage to June 30, 2021 (Feb. 4, 2021)
• 30-Day Suspension of PASRR Requirements (Dec. 21, 2020)
• Telehealth Coverage Extended to March 31, 2021 (Dec. 16, 2020)
• CMS Targeted Payments to PCPs – with BlueCare FAQ attachment (Dec. 2, 2020)
• Extension of Hospital Admin Flexibilities for COVID-19 to March 31, 2020 (Nov. 30, 2020)
• HHS Provider Relief Fund Guidance Reporting Requirements (Oct. 5, 2020)
• Extension of Hospital Admin Flexibilities for COVID-19 (Sept. 30, 2020)
• Nursing Facilities COVID Test Payment for Medicare Enrollees (Sept. 30, 2020)
• CMS Guidance: COVID Test Payment Flow Chart Nursing Facilities (Sept. 30, 2020)
• Federal Relief Funds for Providers Deadline Extended to Sept. 13, 2020 (Sept. 4, 2020)
• Telehealth Coverage Extended to Dec. 31, 2020 (Aug. 26, 2020)
• Federal Relief Funds for Providers Deadline Extended to Aug. 28, 2020 (Aug. 7, 2020)
• CHOICES and CHOICES ECF Residential Special Needs Adjustment and Personal Care Rate Differential (July 28, 2020)
• Federal Relief Funds Deadline Extended to Aug. 3, 2020 (July 21, 2020)
• State of Emergency Extended and Telehealth Coverage Extended (July 2, 2020)
• COVID-19 DME Short-Term Guidance (June 12, 2020)
• HRSA Program FAQ Re: Provider and Facility Reimbursement for COVID-19 Testing and Treatment of Uninsured Patients (June 2020)
• Request to CMS for Targeted Payments to PCPs (June 9, 2020)
• Telehealth Coverage Extended to June 30, 2020 (June 4, 2020)
• Update on Administrative Change Flexibilities (May 8, 2020)
• Guidance and Information for Administrative Changes (April 21, 2020)
• Civil Rights Guidance (April 8, 2020)
• Federal PASRR Requirements (April 1, 2020)

Until further notice, the vaccine costs will be funded by the federal government for our medical plan members across all lines of business. However, reimbursement for administering the vaccine will vary by line of business.

CMS will cover the cost to administer the vaccines to:

• Medicare Advantage and BlueCare Plus members.

TennCare will cover the cost to administer the vaccines to the following members through their Pharmacy Benefit Manager (PBM):

• BlueCare Tennessee and CoverKids members, when administered by a pharmacist.

(CoverKids folded under BlueCare effective Jan. 1, 2021, so the same provisions apply for these members.)

We’ll cover the cost to administer the vaccines to:

• BlueCare Tennessee members, including CoverKids members.
• Commercial members in most cases. Grandfathered employer self-funded health plans (those which existed before the Affordable Care Act) can make their own decisions as to what should be covered.

Claims for vaccines funded by the federal government should not be filed with BlueCross. If you’re an immunizing provider, please file your claims as follows:

Medicare Advantage and BlueCare Plus:

• Hospitals, Health Departments, Pharmacies, and Other (Mobile Units, Group Practices): Submit administration claims to the CMS  Medicare Administrative Contractor’s (MAC) system.

• Hospitals: Submit administration claims to us according to your regular hospital contract.
• Health Departments: Submit administration claims according to your regular health department contract.
• Pharmacies: Submit claims to TennCare’s Pharmacy Benefit Manager (PBM).
• Other (Mobile Units, Group Practices): Submit administration claims according to your regular professional services contract.

• Hospitals: Submit administration claims to us according to your regular hospital contract.
• Health Departments: Submit administration claims according to your regular health department contract.
• Pharmacies: If pharmacy coverage is through BlueCross, submit claims through the BlueCross PBM.
• Other (Mobile Units, Group Practices): Submit administration claims according to your regular professional services contract.

Until further notice during the COVID-19 emergency, our reimbursement for vaccine administration will be consistent with the current CMS rates for Commercial, BlueCare, TennCareSelect and Cover Kids lines of business. Please use the following codes when submitting claims:

• Pfizer
  • 91300 (Effective Dec. 11, 2020)
  • 0001A (Effective Dec. 11, 2020)
  • 0002A (Effective Dec. 11, 2020)
  • 0003A (Effective Aug. 12, 2021)

• Moderna
  • 91301 (Effective Dec. 18, 2020)
  • 0011A (Effective Dec. 18, 2020)
  • 0012A (Effective Dec. 18, 2020)
  • 0013A (Effective Aug. 12, 2021)

• Johnson & Johnson
  • 91303 (Effective Feb. 27, 2021)
  • 0031A (Effective Feb. 27, 2021)

Please note: We’re currently processing claims for the administration of the vaccines listed above. As more vaccines become approved, we’ll add their codes to this list. If you have questions about these vaccines, please refer to the CDC website. Also, Medicare Advantage and BlueCare Plus vaccine administration should be handled per the grid above. The vaccines are currently funded by the federal government and claims shouldn’t be filed with BlueCross.

No, the Division of TennCare has confirmed that dentists should not bill for vaccine administration under BlueCare Tennessee plans. Claims received from dental offices for COVID-19 vaccine administration will be denied.

In April 2020, the TDH began contacting all licensed physicians and pharmacists in Tennessee, including providers, pharmacies and urgent care sites on the Tennessee Immunization Information System (TennIIS) list. You can find details about the TDH’s continued recruitment efforts on their COVID-19 vaccine distribution website. This site also includes the TDH’s draft vaccination plan, currently under review with the CDC.

In addition to state efforts, the federal government has also announced requirements for providers. To receive free supplies of the COVID-19 vaccine(s), providers must sign an agreement with the CDC, agree to vaccinate individuals regardless of the type of coverage they have and not balance bill the patient. The providers also need to meet storage and record-keeping requirements.

The TDH is working to make sure there’s an equitable distribution of vaccination sites across all 95 counties, especially in rural counties and areas with high concentrations of people in vulnerable populations. Providers who wish to administer the COVID-19 vaccine may find more information online at the TDH website. 

Please continue to work with your state and local health department for the latest information on vaccine distribution and availability in your community.

We’re prepared to quickly credential and enroll all immunizing pharmacists during the COVID-19 emergency. Providers should submit a Provider Enrollment Form (PEF) using Availity and declare the need for an expedited enrollment. You can find information about enrollment on our provider website.

When filling out the PEF, please use the Notes section to provide additional information about the expedited request, including the date the practitioner will begin providing services. Once you submit your form, we also recommend you send an email to your Network Manager with the subject line “COVID-19 Request.” That way, they can help prioritize your request with our enrollment team. Please include your expected start date and the PEF number you receive from your application.

Please note, pharmacies still need to manage enrollment through the Pharmacy Benefit Manager (PBM) for each line of business.

According to the TDH, there are still restrictions based on CDC guidelines. As of April 19, all U.S. residents age 16 and older are eligible for the vaccine.  As of May 12, 2021, children age 12 and up are eligible for the Pfizer vaccine. At this time, Pfizer is the only vaccine that can be administered to individuals under the age of 18.

Your patients can check their local health department or visit VaccineFinder.org to find vaccine locations. The U.S. Department of Health and Human Services has also created a national hotline to help connect people with disabilities to information about the COVID-19 vaccine. The Disability Information and Access Line (DIAL) can help callers find vaccine locations, schedule appointments and access community services, like transportation. Your patients can reach the hotline by calling 1-888-677-1199 or emailing DIAL@n4a.org. Calls are answered Monday through Friday between 8 a.m. and 9 p.m. ET.

Several websites offer helpful information about COVID-19 vaccines, including availability and care recommendations.

For news at the state level, the TDH regularly updates information about vaccine development and plans for administration on their COVID-19 website. They also post frequent webinars to keep providers up to speed. If you want the latest news by email, you can subscribe for updates at the bottom of this page.

Likewise, the Tennessee Hospital Association (THA) website has a number of communications guides designed to help providers talk to their patients about the vaccines. This includes recorded webinars with medical experts, presentations, vaccine toolkits and more. You can access the THA materials at tha.com.

For news at the federal level, you may want to visit the CDC COVID-19 vaccination site and the FDA COVID-19 site. The Centers for Medicare & Medicaid Services (CMS) have also issued toolkits to help providers prepare for vaccination administration once the vaccines become available.

As always, we’ll continue to provide updates on this BCBSTupdates.com site as we receive new information.

As your patients’ trusted source for health-related information, it’s essential that you and your staff are prepared to speak to concerns they may have about the virus and vaccines. The CDC offers helpful information to guide discussions with patients here.

Since mid-November, the Tennessee Department of Health has been shipping monoclonal antibody products to Tennessee providers and infusion centers that agreed to administer the treatment. They’ve been supplied by the federal government and are free of charge. 

CMS has provided guidance about the coverage of administration costs, and we’re working to update our processes to be compliant for BlueCare claims payment purposes. Please use the following code when billing for administering the monoclonal antibody treatment to BlueCare members:

• M0243 – Casirivimab/Imdevimab (Effective Nov. 21, 2020)
• M0244 – Casirivimab/Imdevimab (Effective May 6, 2021)
• M0246 – Bamlanivimab/Etesevimab (Effective May 6, 2021)

Since Feb. 4, 2020, we’ve covered our members’ cost-share for COVID-19 testing, related office visits and services. This includes reimbursement for multiple tests of the same patient.

Please help us identify your COVID-related claims by using the CS modifier for these types of services provided after March 18, 2020, and through the COVID-19 emergency. When billing with the CS modifier, please be sure to use the appropriate modifiers, per guidelines from the AMA, CMS, etc. This policy applies to FDA-approved tests and those currently pending FDA approval. It also applies to testing performed by providers outside of our network.

Yes, we are waiving prior authorization requirements for the testing and treatment of coronavirus during the COVID-19 emergency. However, we aren’t suspending other prior authorizations. We have prior authorizations in place for several reasons, but mainly to make sure treatments are covered and our members don’t pay more than they should.

From Feb. 4, 2020, until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes for all contracted and non-contracted labs and providers across all BlueCross BlueShield of Tennessee product lines:

• U0001 – CDC
• U0002 – Commercial Labs
• CPT^® code 87635 to be priced at the U0002 payment or the lesser of billed charges once physicians can do their own testing
• U0003 and U0004 – High-Throughput Testing (Effective April 14, 2020)
• 87426 (Effective June 25, 2020)
• 87636 (Effective Oct. 6, 2020)
• 87637 (Effective Oct. 6, 2020)
• 87811 (Effective Oct. 6, 2020)
• 0240U (Effective Oct. 6, 2020)
• 0241U (Effective Oct. 6, 2020)
• 87428 (Effective Nov. 10, 2020)
• U0005 (Effective Dec. 4, 2020)

From March 1, 2020, until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes to ensure timely payment.

• G2023 – home/nursing home collection
• G2024 – home/nursing home collection
• C9803 – hospital outpatient

Yes. Testing guidelines for these circumstances are outlined below:

• COVID-19 testing done 72 hours before an admission/outpatient procedure will pay “in addition” to the procedural reimbursement.
• COVID-19 testing done less than 72 hours (i.e., 48 hours), but prior to the day of the admission/outpatient procedure, will pay “in addition” to the procedural reimbursement.
• COVID-19 testing done the day of the OP procedure and billed on the same claim as the OP procedure will pay “in addition” to any OP procedure. Inpatient admission will be included in the DRG charge.

Please note: The test will be covered even if the member’s admission/OP procedure is canceled due to a positive COVID-19 test.

Yes. COVID-19 testing performed as part of an emergency room visit will be reimbursed separately from the emergency room visit. Please note: For ER claims, the COVID-19 test should be included on the same claim as the ER services being billed.

We’re waiving member cost-share for in-network COVID-19 treatment, including hospitalization, until further notice during the COVID-19 emergency. Out-of-network treatment will be subject to out-of-network benefits and our out-of-network allowed amounts.

No. We understand that, as businesses reopen and adapt their health and safety practices, many require routine COVID-19 testing as part of their return-to-work or ongoing safety procedures. Employment-based COVID testing is not part of our members’ health plan benefits, similar to pre-employment and periodic drug testing, and coverage for it isn’t included under the CARES Act. We’ll continue to cover the full cost of COVID-19 testing that’s recommended by a member’s health care provider based on their symptoms, risk or exposure. And until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval.

No. We understand that many schools have revised their health and safety protocols to require COVID-19 testing as part of their return-to-school policy for students. However, school-mandated testing isn’t part of our members’ health plan benefits. We’ll continue to cover the full cost of COVID-19 testing that’s recommended by a member’s health care provider based on their symptoms, risk or exposure. Until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval.

Yes. We’ll cover our members’ swabs and test results in a drive-through setting as part of the lab payment. However, we’ll only reimburse for our members’ COVID-19 swabs and test results in drive-through testing.

*Codes included on preferred lab exclusion list for BlueCare, TennCareSelect and CoverKids.

The CDC has linked to each state’s department of health contact information for testing. Here’s a link to the CDC site: cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html.

We’ll pay for FDA-approved versions of these tests when they’re ordered by an in-network physician during in-person or telehealth appointments.

Many of the antibody tests marketed have proved to be ineffective, so we’ll only cover the ones that the FDA has cleared, approved or given emergency use authorization for. Like you, we’re deeply invested in making sure our members get safe, effective and conclusive tests, while minimizing false or misleading diagnoses.

If the above conditions are met, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes to ensure timely payment:

• 86328 and 86769 – Antibody Testing During Appointment
  Effective for dates of service April 10, 2020, until further notice during the COVID-19 emergency.
• 0224U – Antibody Testing During Appointment
  Effective for dates of service June 25, 2020, until further notice during the COVID-19 emergency.

We’ll pay for at-home tests that diagnose current disease when they’re ordered by a licensed physician. Many of the at-home tests marketed have been proved ineffective, so we’ll cover just those the FDA has cleared, approved or given emergency use authorization for. Like you, we’re deeply invested in making sure our members get safe, effective and conclusive tests, while minimizing false or misleading diagnoses.

Yes.  Beginning March 16, 2020, until further notice, you may use the following codes to bill for telehealth. We’re currently evaluating our telehealth policies and will let you know in advance if we plan to make changes.

• CPT^® codes 99441 – 99443 for audio/telephonic provider-to-member consultations for all lines of business’s PCP or specialist benefits.
• E/M codes 99201 – 99215 for virtual and audio/telephonic consults with your patients.
• E/M codes 99421 – 99423 for non-face-to-face digital online consultations.
• CPT^® codes 98970, 98971 and 98972 for online assessments and management.
• HCPCS code G2010 for remote evaluation of video and/or images.
• HCPCS code G2012 for virtual check-ins with your patients.
• CPT® codes 90791, 90792, 90832, 90834, 90837, 90847 and 90853 for behavioral health initial evaluation and therapy.
• CPT^® codes H0032 and H2019 (with or without a modifier HO) for Applied Behavior Analysis (ABA) therapy.
• In addition, here are some more recent behavioral health codes.

Click here for a full guide on BlueCare Tennessee telehealth services.

When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02 or your normal Place of Service code with a 95 modifier appended to the CPT^®/HCPCS code. This will let us know you’ve treated our member using telehealth.

The Division of TennCare posts regular updates, including recommendations on providing care for Long-Term Services and Supports (LTSS) members in home settings. Visit the site for helpful advice.

Yes. We’ll cover these visits with in-network providers until further notice.

Please bill them with the appropriate Revenue code and the DR (Disaster Recovery) condition code.

Specific outpatient PT/OT/ST CPT^® codes are included as part of the temporary expansion of telehealth services as a result of the COVID-19 emergency.

• Effective beginning March 18, 2020, until further notice
• Providers supported by this exception are licensed physical therapists, occupational therapists and speech-language pathologists.
• All services provided are medically appropriate and necessary.
• The services must take place in real time, and the patient and provider are connected via an interactive audio and video telecommunications system.
• All relevant online communications about the member’s medical care and follow-up are included in their medical record.
• Any existing visit limitations and/or prior authorization requirements continue to apply.

When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02 or your normal Place of Service code with a 95 modifier appended to the CPT^®/HCPCS code. This will let us know you’ve treated our member using telehealth.

Category	CPT® Code	Description
Physical Therapy	97161	Physical therapy evaluation – low complexity
Physical Therapy	97162	Physical therapy evaluation – moderate complexity
Physical Therapy	97163	Physical therapy evaluation – high complexity
Physical Therapy	97164	Physical therapy re-evaluation
Physical Therapy	97110	Therapeutic procedure, one or more areas, each 15 minutes
Physical Therapy	97116	Gait training
Physical Therapy	97530	Therapeutic activities, one-to-one patient contact, each 15 minutes
Physical Therapy	97112	Therapeutic procedure, one or more areas, each 15 minutes
Physical Therapy	97535	Self-care/home management training, each 15 minutes
Occupational Therapy	97165	Occupational therapy evaluation – low complexity
Occupational Therapy	97166	Occupational therapy evaluation – moderate complexity
Occupational Therapy	97167	Occupational therapy evaluation – high complexity
Occupational Therapy	97168	Occupational therapy re-evaluation
Occupational Therapy	97110	Therapeutic procedure, one or more areas, each 15 minutes
Occupational Therapy	97530	Therapeutic activities, one-to-one patient contact, each 15 minutes
Occupational Therapy	97112	Therapeutic procedure, one or more areas, each 15 minutes
Occupational Therapy	97535	Self-care/home management training, each 15 minutes
Speech Therapy	92507	Treatment of speech, language, voice, communication and/or auditory processing disorder
Speech Therapy	92521	Evaluation of speech fluency
Speech Therapy	92522	Evaluation of speech sound production
Speech Therapy	92523	Evaluation of speech sound production
Speech Therapy	92526	Treatment of swallowing dysfunction and/or oral function for feeding
Speech Therapy	96105	Assessment of Aphasia and Cognitive Performance Testing
Speech Therapy	97129	Therapeutic interventions that focus on cognitive function
Speech Therapy	97130	Each additional 15 minutes (use in conjunction with 97129)

Excluded from this temporary expansion of telehealth services:
Any treatment that requires specialized hands-on care or specialized equipment, such as whirlpools, etc. This includes Athletic Trainings (97169 – 97172), Modalities (97010 – 97039) and Group Therapies. Any member currently receiving group therapy should be considered for individual therapy via telehealth.

Yes. You can use E/M codes to bill for telehealth with both new and established patients.

No. Only contracted and credentialed physicians, specialists, Nurse Practitioners and Physician Assistants can bill for telehealth services. Additionally, Nurse Practitioners and Physician Assistants who provide telehealth services must be supervised by a contracted physician. Claims should be billed per Provider Administration Manual guidelines.

No. Our priority is to support our members, which may include exploring ways to temporarily relax or suspend clinical and administrative policies. Right now, our current policies remain in place. During the COVID-19 emergency, however, we’re closely monitoring the changes to federal and CMS guidelines and will align with any updates they release.

Yes. BlueCare Tennessee aligns with recent CMS regulations, which allow for telehealth visits via platforms like Apple FaceTime, Facebook Messenger video chat, Skype, Google Hangouts video and Zoom.

If there is a COVID-19 diagnosis, we are waiving the cost-share for telehealth services performed by network providers. If telehealth is being provided for other conditions, we will continue to apply cost-share to our members.

No. We don’t cover chiropractic services for telehealth.

Yes. We encourage our patients to use telehealth benefits when possible. We also encourage patients to avoid using the emergency room, except in a true medical emergency, to prevent the spread of illness.

Telehealth has made it easier for members to access health care, so we’ve decided to continue to support telehealth services for our Commercial line of business for in-network providers who offer them. Until further notice, BlueCare Tennessee, Medicare Advantage and BlueCare Plus will continue covering telehealth during the COVID-19 emergency, as we have for the past several months.

We strive to deliver important updates to you quickly through this Provider FAQ, so some details may conflict with what’s already been published in our Provider Administration Manuals (PAMs). If you find information in this Provider FAQ conflicts with a provision in a PAM, the Provider FAQ information will temporarily take precedence over previously published information in the PAM during this pandemic. If you have questions or need clarification, please contact your Network Manager.

You should continue using the same credentialing and enrollment processes; but let us know of any constraints or delays that you have with third-party requirements, such as CMS or accreditation. We can process your application with this additional information, and make it part of your file for our Credentialing Committee to assess. The Committee may decide to approve the application for a shortened period of time and require you to re-credential earlier to ensure that pending requirements have been satisfied.

We’re adhering to the emergency directives set forth in the State of Tennessee Executive Order by the governor, available here.

BlueCare is prepared to quickly credential and enroll all initial applicants during the COVID-19 emergency. Providers should submit a PEF and declare the need for an expedited enrollment due to the current COVID-19 emergency. You can do this by checking the COVID-19 Emergency Declaration check box, which will tell us you believe the request is related to the location and/or enrollment waivers. It will also route your enrollment to the appropriate area for review.

When you submit your form, we recommend emailing your Network Manager with the subject line “COVID-19 Request,” and include the PEF number so they are aware of the request as well as the dates the practitioners need to begin providing services.

You don’t need to notify us if the billing Group NPI, Tax ID and Individual NPI on the claim will be the same for the practitioner at either location. Reimbursement won’t change, and claims will process under the practitioner’s existing setup for that network.

Please email your Network Manager using the subject line “COVID-19 Request” so they can help you with any changes needed to your existing contract.

If your office or one of your practice locations will be closed for an indefinite period, we suggest you submit that information to us in a Change Form. In the Office Hours section of the Change Form, please indicate all days that each specific location will be closed. We’ll update our member-facing, online provider directory to reflect this closure until we receive an update from you.

Your practitioners, office locations and networks will continue to display in the directory as usual, with the exception of the Location & Hours section. When the office reopens, please submit a new Change Form with the correct office hours for the location.

Thank you for continuing to keep your phone lines and websites up to date with the latest information about your practice’s policies and hours or if you’re redirecting patients to other providers. We’re reminding members to check with you before any office visit.

We understand this is a confusing time. We want to keep you updated so we can work together to care for your patients and our members. We’ve received your questions and we’re regularly posting answers in our provider FAQs and in Availity. You can also help us communicate with you better by telling us how you prefer to be contacted. Just submit that information in Availity.

Yes. We continue to be committed to serving our members and providers during the COVID-19 emergency. We acted quickly to make sure our employees could work effectively from home while practicing social distancing. At the same time, we’ve prioritized our claims, customer service and clinical operations. We’re monitoring the situation and our service metrics, and will revisit as needed.

Yes. The following coronavirus/COVID-19 diagnosis codes have been added to the medical emergency list for all lines of business:

• B97.29
• B97.21
• Z03.818
• Z20.828
• U07.1

We allowed early refills through much of 2020, but this benefit ended on Jan. 1, 2021.

Patients taking certain chronic medications may receive 90-day refills. The 90-day supply benefit established at the beginning of the COVID-19 emergency for certain prescriptions will become permanent on Sept. 1, 2021, and you can view the list of eligible medications here. Controlled substances, such as opioids, and specialty drugs are excluded from this benefit.

Additionally, your patients with BlueCare Tennessee coverage may use delivery services offered through local pharmacies.

We’ll cover home births with a certified nurse midwife for our members who have that benefit. We recommend home births only for low-risk pregnancies, and the member must have a detailed birthing plan that includes a hospital and doctor, in case of complications. For more information, please refer to your Provider Administration Manual.

Yes. With the recent rise in COVID-19 cases, the Division of TennCare is reinstating the PCP assignment waiver until further notice. Members with BlueCare, TennCareSelect or CoverKids coverage will still be assigned a primary care provider; but you won’t be denied payment if you treat a patient who isn’t assigned to you or a provider in your practice.

We had previously waived the PCP lock-in process through July 31, 2021; but we understand that the COVID-19 emergency has continued to strain physician practices. So, if you filed a claim that was denied on or after Aug. 1, 2021, due to PCP assignment requirements, your claim will be reprocessed and retroactively approved.

To help our providers, we temporarily delayed recoupments. Effective May 15, 2020, we resumed recoupment for funds we’ve overpaid to individual providers. On direction from the Division of TennCare, recoupments and audits for facilities were suspended through March 31, 2021, and resumed April 1, 2021.

No. We don’t cover these additional supplies under our health plans.

If you want to extend an existing prior authorization that’s already been approved for an elective procedure, please contact us directly and we’ll work with you to change the date of service. Otherwise, please see below for prior authorization validity periods currently in place:

• We’re working with providers to change the dates of service to the date they call in.
• There’s currently no limit on how far in the advance we’ll change the date.

No. Our priority is to support our members, which may include exploring ways to temporarily relax or suspend clinical and administrative policies. Right now, our current policies remain in place. During the COVID-19 emergency, however, we’re closely monitoring the changes to federal and CMS guidelines and will align with any updates they release.

No. We aren’t waiving the requirement for chronic conditions, as this is a CMS requirement. During the COVID-19 emergency, we’re closely monitoring the changes to federal and CMS guidelines and will align with any updates they release.

No. In light of COVID-19, we are prioritizing the processing of all requests. During the COVID-19 emergency, we want to support our provider partners so they can focus on dealing with this health crisis. Currently our requirement for timely filing is 120 days.

Due to the rise in COVID-19 cases and at the request of the Tennessee Hospital Association, the Division of TennCare is reinstating the prior authorization requirement waiver for initial post-acute care review. Until further notice, authorization isn’t required before moving patients from an acute care setting to a post-acute care setting (Skilled Nursing Facility, Rehab and LTACH).

This waiver supports rapid placement and discharge of currently hospitalized patients who can be safely discharged to another setting, and we had previously waived this requirement until June 30, 2021.

No. Our priority right now is to support our members by exploring ways to temporarily relax or suspend clinical and administrative policies, and offering premium extensions.

Yes. The Division of TennCare has announced an early RSV season, with a retroactive effective date of Aug. 1, 2021. Synagis injections are approved only for use during RSV season, which typically begins Nov. 1 and ends March 31. Our pharmacy department is working with Magellan Rx to update authorization guidelines so Synagis injections are available during the extended season.