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
Amended and Restated Contractor Risk Agreement - East MCO Contract
Amended and Restated Contractor Risk Agreement - West MCO Contract
TennCare Select Agreement (effective 7-1-01) ![]()
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.
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.