Q1: What happens when I refer a member to an out-of-network facility?
A1: Please use caution when referring a member to an out-of-network facility or program. Members may be held responsible for the total claim charges or for a greater amount of financial liability
Q2: If Electroconvulsive Therapy (ECT) is done on an outpatient basis, does it need to be reviewed and authorized?
A2: All ECT needs to be reviewed and authorized, regardless if the procedure is done inpatient or on an outpatient basis. This is to ensure the procedure is medically necessary and is performed in an appropriate setting for patient safety. Note: ECT performed in an office setting is not a covered benefit.
Q3: If I am a Magellan provider, can I serve all BlueCross BlueShield of Tennessee members as a participating provider?
A3: No. You must have a BlueCross BlueShield of Tennessee contract with Magellan in order to treat BlueCross BlueShield of Tennessee members as a participating provider
Professionals and Facilities may contact 1-800-297-7821.
Q5: Who is my Provider Relations representative?
A5: If you are an In-Network provider, Magellan serves as your Provider Relations representative. For questions, Professionals and Facilities may contact 1-800-297-7821. For claims and benefits information, contact BlueCross BlueShield of Tennessee’s Provider Services at 1-800-924-7141.
If you are not contracted with Magellan, you may contact BlueCross Blue Shield of Tennessee’s Provider Services (800) 924-7141 for claims and benefits information and to obtain an out-of-network BlueCross BlueShield provider number.
Q6: If I am a provider with offices in the state of Tennessee and/or counties contiguous to the state of Tennessee and see a member from another state's BlueCross BlueShield plan, where should my claims be filed?
A6: You should file your claims with your local BlueCross BlueShield plan unless you have a contract with the member’s out-of-state plan.