5010 Implementation-Changes to Provider Claims Formats

As of January 1, 2012, all BlueCare/TennCareSelect claims must be submitted in the 5010 format. This impacts electronic claims, as well as claims submitted on the CMS-1450 and CMS-1500 paper claim forms.  All providers listed on claims must be reported in a manner that is compliant with established guidelines.  Additional information may be found in the documents below.

Letters to Providers

• VSHP Provider Letter
• BCBST Provider Letter

Usage Grid

Effective 07/01/01 - 12/31/08

• Amended and Restated Contractor Risk Agreement Between The State of Tennessee and Volunteer State Health Plan, Inc. d.b.a. BlueCare 

Effective 01/01/09

Amended and Restated Contractor Risk Agreement - East MCO Contract  

• BlueCare East MCO Amendment 1
• BlueCare East MCO Amendment 2
• BlueCare East MCO Amendment 3
• BlueCare East MCO Amendment 4
• BlueCare East MCO Amendment 5
• BlueCare East MCO Amendment 6
• BlueCare East MCO Amendment 7

Effective 11/01/08 

Amended and Restated Contractor Risk Agreement - West MCO Contract 

• BlueCare West MCO Amendment 1
• BlueCare West MCO Amendment 2
• BlueCare West MCO Amendment 3
• BlueCare West MCO Amendment 4
• BlueCare West MCO Amendment 5
• BlueCare West MCO Amendment 6
• BlueCare West MCO Amendment 7

TennCare Select Agreement (effective 7-1-01)

• TennCare Select Agreement – Amendment 1
• TennCare Select Agreement – Amendment 2
• TennCare Select Agreement – Amendment 3
• TennCare Select Agreement – Amendment 4
• TennCare Select Agreement – Amendment 5
• TennCare Select Agreement – Amendment 6
• TennCare Select Agreement – Amendment 7
• TennCare Select Agreement – Amendment 8
• TennCare Select Agreement – Amendment 9
• TennCare Select Agreement – Amendment 10
• TennCare Select Agreement – Amendment 11
• TennCare Select Agreement – Amendment 12
• TennCare Select Agreement – Amendment 13
• TennCare Select Agreement – Amendment 14
• TennCare Select Agreement – Amendment 15
• TennCare Select Agreement – Amendment 16
• TennCare Select Agreement – Amendment 17
• TennCare Select Agreement – Amendment 18
• TennCare Select Agreement – Amendment 19
• TennCare Select Agreement – Amendment 20
• TennCare Select Agreement – Amendment 21
• TennCare Select Agreement – Amendment 22
• TennCare Select Agreement – Amendment 23
• TennCare Select Agreement – Amendment 24
• TennCare Select Agreement – Amendment 25
• TennCare Select Agreement – Amendment 26
• TennCare Select Agreement – Amendment 27

• Abortion, Sterilization, Hysterectomy
  • Abortion Checklist 
  • Sterilization Checklist 
  • Hysterectomy Checklist 
• Behavioral Health
• Blood Lead Screening 
• CareAdvance
• Culturally Effective Care Tool Kit
• BlueCare / TennCareSelect Disclosure
  • Disclosure Form for a Provider Person
  • Disclosure Form for Provider Entities
  • Disclosure FAQs (112kB)
• Grier Consent Decree Information
• BlueCare/TennCareSelect - Global and Category II Codes FAQs 
• Long-term Care
• • Long-term Care Transformation Frequently Asked Questions  
• Medical Emergency Code List (sorted by description) 
• Medical Emergency Code List (sorted by code) 
• Medication Dispensed in Physician's Office 
• Non-discrimination Compliance Training
• Private Duty Nursing and Home Health Benefit Changes
• Provider Administration Manual
• Provider Alerts
  • Provider Initiated Notice - Adverse Action (Electronic Form)  
  • Provider Initiated Notice - Adverse Action  
  • Crisis Information  
• Remittance Explanation Codes 
• Retrospective Review FAQs 
• Specialty Pharmacy Master Clinical Drug List 
• Specialty Pharmacy Medication Requiring Prior Authorization
• TennCare Eligibility 
• BlueCare/TennCareSelect Tennessee Medicaid Number FAQs 
• TennCare/Medicaid Provider Enrollment Forms 
• TennCare Preferred Drug List 
  • Pharmacy Short List  
• TennCare Updates/News/Letters
• TennCareSelect Agreement and Amendments 
• TENNderCARE Tool Kit
• Transportation Services  
• VSHP Important Information February 1, 2011
• 07/01/11 Bureau of TennCare Memo and False Claims Act Clarification
• Additional Clarification of the Violation of the Medicaid False Claims Act

• November 19 Update
  The Centers for Medicare & Medicaid Services website has been updated with the NCCI edits that have a 10/01/10 effective date.  You may access them at:  http://www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.

• National Correct Coding Initiative

• PDL Notice 01/01/11
• PDL Notice 10/01/10 
• Provider Notice Diabetic Supplies Clarification 10/01/10 
• Provider Notice for Nexium 10/01/10 
• Smoking Cessation Agents In Pregnancy 10/01/10 

The Centers for Medicare & Medicaid Services released new information regarding the Vaccines for Children (VFC) program.  New CPT vaccine administration codes will be used for the VFC vaccines (90460 and 90461).  Per the attached memo from the Department of Health, the instructions for reimbursing the VFC administration codes will continue to be based on a per-vaccine (per unit) basis and NOT on a per antigen or per component basis. 

For non-VFC services, reimbursement will be on a per component basis.

• VFC Vax Admin CPT guidance 12-30-10
• VFC Guidance August 2011

• 2009 TennCare Master Drug List 
• 2010 pecialty Pharmacy Master Clinical Drug List 
• Laboratory Test Codes Excluded from LabOne Arrangement (0.09 MB)
• Preferred Drug List Update - Azmacort- Effective 1/1/10 
• Preferred Drug List Changes Effective 1/1/10 
• Preferred Drug List Update -Depakote ER - Effective 11/1/09
• Preferred Drug List Changes Effective 10/15/09 
• Preferred Drug List Changes Effective 8/28/09
• Preferred Drug List Changes Effective 7/1/09 
• TennCare Branded Drugs To Be Classified As Generics Effective 7/1/09 
• Preferred Drug List Changes Effective 7/01/09 
• Preferred Drug List Changes Effective 4/15/09 
• Preferred Drug List Changes Effective 2/9/09 
• Preferred Drug List Changes Effective 1/1/09 
• Preferred Drug List Changes for Proton Pump Inhibitors Effective 10/1/08 
• Preferred Drug List Preferred Diabetic Testing Products Effective 01/01/09 
• Preferred Drug List Changes Effective 10/1/08
• Tenncare East and West Provider Letter 
• Tenncare East and West Frequently Asked Questions 
• Preferred Drug List Changes Effective 04/01/08
• Implementation Date for Tamper-Resistant Prescription Pads for TennCare Prescribers
• Tamper-Resistance Prescription Pad Requirement Delayed
• Preferred Drug Changes Effective 10/03/07
• Beginning October 1, 2007, TennCare Scripts Must Use Tamper-Resistant Pads
• Preferred Drug List Changes Effective 08/01/07
• Preferred Drug List Changes Effective 07/02/07
• High Potency Statin Preferred Drug List Changes Effective 07/02/07 (Revised Effective Date)
• Preferred Drud List Changes Effective 5/22/07
• Injectable Drugs Covered Through Pharmacy POS Effective 05/01/07
• Products That Are NOT Self Administered Effective 5/1/07
• Products that are NOT self-administered / Non-Self-Administrable Drug List Effective 04/09/07
• TennCare NPI Transition Information Effective 04/24/07
• Middle Tennessee Transition of Care
• Zoloft® and sertraline PDL Update Effective 01/12/07
• Middle Tennessee Transition - Provider Fact Sheet - Policy Brief and FAQs
• Middle Tennessee Letter 02-21-07- Providers and Advocates
• Middle Tennessee Transition Advocate Fact Sheet - Policy Brief and FAQs
• Bureau of TennCare National Provider Identifier (NPI) collection process from Medicaid providers
• Preferred Drug List Changes Effective 03/01/07
• Important Clarification to BlueCare and TennCareSelect Medical Necessity Review Requirements 
• Fast Facts - TennCare Pharmacy Prescription Limit Override Process Effective 02/01/07
• Prescription Limit Override Process Effective 02/01/07
• TennCare Prescriber Attestation List
• Preferred Drug List Changes Effective 02/07/07 
• Prior Authorization Fax Forms/Override Codes
• Preferred Drug List Update - Proair® (1/2007)
• Preferred Drug List Changes Effective 01/04/07
• External Quality Review 0117061
• Important Notification regarding TennCare from First Health - Medicare Part D
• Reminder: Populating Secondary Diagnoses
• Pharmacy Contract Changes Effective 07-01-2006(0.03 MB)
• Best Practice Network (BPN) Eligibility No Prior TennCare Coverage
• Best Practice Network (BPN) Eligibility Prior TennCare Coverage
• TennCare Reform