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Commercial Behavioral Health Network

BlueCross BlueShield of Tennessee is committed to ensuring our members receive quality services from a network of dedicated health care professionals. One way we deliver on this commitment is to build, maintain and provide excellent service to a network of providers who can meet the many, and often complex, health care needs of our members.

To continue providing the highest quality and value to our members who require care from behavioral health providers, BlueCross will now directly contract all behavioral health providers.

As of Jan. 1, 2016, all behavioral health providers treating BlueCross members will be credentialed and contracted with BlueCross. Learn more about our effort through this presentation or the brief 10-minute recording

Frequently Asked Questions are also available.

Transition of Care

We have plans in place to ensure our members have access to the behavioral health care they require. Providers who choose not to contract directly with BlueCross will be required to care for our members for a 120 day transition period or until members complete their episode of care, whichever is shorter. During this time, all claims will continue to be paid at providers’ previous in-network rates and automatically processed at each member’s in-network benefit levels.

Following the transition period, members who receive care from non-BlueCross behavioral health providers will be subject to out-of-network benefits, rates and coinsurance as specified by their plans.

New MCG® Behavioral Health Care Guidelines

The MCG Behavioral Health Care Guidelines are evidence-based clinical guidelines that facilitate the appropriate level of care, more accurately manage episodes of care and help enhance the discharge planning process.

Adopted MCG Guidelines for Mental Health and Substance Use include:

  • Inpatient – Adult/Child/Adolescent
  • Residential – Adult/Child/Adolescent
  • Partial Hospital – Adult/Child/Adolescent
  • Intensive Outpatient – Adult/Child/Adolescent
  • Psychological Testing

Modified/New MCG Guidelines include:

  • Eating Disorder add-on criteria for all Eating Disorder Levels of Care
  • Detox add-on criteria specific to pregnant women

Behavioral Health Contacts

Should you have questions, please contact the appropriate regional network manager.

East Knox Region
Anna Smith
Network Manager
(865) 588-4637
Anna_Smith@bcbst.com

Middle Region
Lee Green
Network Manager
(615) 483-7886
Lee_Green@bcbst.com

East Chattanooga Region*
Sam Hatch
Network Manager
(423) 535-4204
Sam_Hatch@bcbst.com

West Region
Phillip Gomez
Network Manager
(731) 664-4122
Phillip_Gomez@bcbst.com

Middle Region*
Jennifer Ramsden
Network Manager
(423) 535-3807
Jennifer_Ramsden@bcbst.com

Upper East Region*
Catherine Overstreet
Network Manager
(423) 535-6013
Cathy_Overstreet@bcbst.com

*These network managers support adjoining regions and may be assigned as needed to best meet your needs.

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