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BlueCare Tennessee | February 2017

This information applies to BlueCareSM and TennCareSelect plans, excluding CoverKidsSM and dual-eligible BlueCare Plus (HMO SNP)SM unless stated otherwise.


Latest TennCareSM PDL Includes Changes for Anti-Migraine Drugs and Ophthalmic Agents

The latest release of the TennCare Preferred Drug List (PDL) includes changes that may affect some of the medicines your patients take. Some of the most notable changes are related to Anti-Migraine: 5-HT1 Receptor Agonists, Hereditary Tyrosinemia Agents and Ophthalmic Immunomodulators.

In addition, some agents were removed from the list of branded agents classified as generics.
Click here for the most current PDL.
Click here for the notice of PDL changes effective Jan. 1, 2017.


Document Any Refusal to Vaccinate

Each parent or patient has the right to refuse recommended vaccines. If the parent or patient decides not to get recommended immunizations, their decision must be documented in the patient’s medical record. Resources for documenting the refusal are available on the American Academy of Pediatrics website. Additionally, the Centers for Disease Control and Prevention website has conversation tools to help talk with parents and patients about the importance of immunizations and the importance of preventive care.


BEHIP II Training Now Available

BlueCare Tennessee is proud to sponsor Behaviorally Effective Healthcare in Pediatrics (BEHIP) training along with the Tennessee Chapter of the American Academy of Pediatrics and Vanderbilt University School of Medicine. Providers can take advantage of free training modules online, and earn 2.5 AMA PRA Category CreditsTM per completed module. Most courses take as little as an hour to complete.

Topics this training session includes:

  • Trauma and early brain development
  • Trauma competent care principals in a primary care setting
  • Psychopharmacology
  • Motivational interviewing
  • Working with children and families in the child welfare system

This is the second part of training for an ongoing program that equips providers to improve diagnoses and care for patients with behavioral health conditions. To date, hundreds of providers across the state have already used this free resource.

To learn more about BEHIP II training, please contact TNAAP Training Coordinator Heather Smith at heather.smith@tnaap.org.


Your Timely Response is Needed for Medical Records Requests

Often medical information or records are needed to process member claims, to determine reimbursement levels for certain procedures and for audits/reviews by the Bureau of TennCare. To reduce delays in claims processing, it is important that providers respond to these requests as quickly as possible.

Please note the following guidelines regarding medical record requests:

  • Submit the request letter as the first page of your medical record.
  • Fax the requested information to the number listed in the letter.
  • Submit only the requested information.

Copies of the claim are not required. If claim copies are included, please attach behind the medical record.


Population Health is Available for Eligible CoverKidsSM Patients

We can partner with you to help eligible CoverKids patients with certain conditions that need special care, including programs for tobacco cessation, weight management and transplant management. To refer a patient to the program, please complete a CoverKids Population Health Form. and submit by email to DMScreeners_GM2@bcbst.com or by fax to 1-800-421-2885.


New Process for Submitting Population Health IEPs for CoverKids Members

Eligible CoverKids patients now have access to Population Health Individual Education Plan (IEP) services. To submit a request for your patient, please fax the IEP along with the Parental Authorization Release Form to 1-800-851-2491.


Reminder: Seven Required Components of a TennCare Kids Checkup

According to evidence-based guidance from the American Academy of Pediatrics, all seven components of a TennCare Kids physical exam must be performed and documented in the patient’s medical record. The date of the exam and documentation of the nutritional assessment and physical activity portion of the exam must be included. If the child is uncooperative or the examination was deferred or refused, be sure to include this information in the medical record.

  1. Comprehensive Health (Physical and Mental) and Developmental History
    • Initial and Interval History
    • Developmental/Behavioral Assessment
  2. Comprehensive Unclothed Physical Exam
  3. Vision Screening
  4. Hearing Screening
  5. Laboratory Tests
  6. Immunizations
  7. Health Education/Anticipatory Guidance

Helpful services and required medical record documentation criteria for the TennCare Kids exam are available on the Tennessee Chapter of the American Academy of Pediatrics website.


BlueCross BlueShield of Tennessee complies with the applicable federal and state laws, rules and regulations and does not to discriminate against members or participants in the provision of services on the basis of race, color, national origin, religion, sex, age or disability. If a member or participant needs language, communication or disability assistance, or to report a discrimination complaint, please, call 1-800-468-9698 for BlueCare, 1-888-325-8386 for CoverKids or 1-800-263-5479 for TennCareSelect. For TTY help call 771 and ask for 888-418-0008.

Information about the civil rights laws can be found at http://www.bcbst.com/ or from the Department of Health and Human Services at http://www.hhs.gov/ocr/index.html.

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