Frequently Asked Questions

General Questions

Q1: If I have questions about a medical determination, can I speak directly with a BlueCross BlueShield physician?
A1: It is the policy of BlueCross BlueShield of Tennessee to make available to treating practitioners a physician-to-physician review to discuss, by telephone, determinations based on medical appropriateness. A physician-to-physician review may be initiated by calling 1-800-228-2096.
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Q2: If I am participating in any one of BlueCross BlueShield’s provider network programs (i.e. HMO Blue), am I allowed to participate in any of the other networks?
A2: Participation in each BlueCross BlueShield of Tennessee provider network requires the execution of a separate network attachment to the provider’s core (master document) contract. The provider must also satisfy applicable network participation and credentialing requirements established by BlueCross BlueShield of Tennessee.
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Q3: If I have not received my individual provider number, or if multiple providers within a group delivered services, can I bill using our group number?
A3: All HCFA-1500 claims must be filed with an individual provider number. Any questions regarding an individual provider number should be directed to our Provider Information Department: (423)535-5775
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Q4: What is THCN?
A4: Tennessee Health Care Network (THCN) is a wholly owned subsidiary of BlueCross BlueShield of Tennessee. THCN holds the license for the HMO business.
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Q5: Does BlueCross BlueShield have one number which I can call to access all lines of business for general information?
A5: BlueCross BlueShield of Tennessee has established a telephone number which can be used for inquiries regarding members and providers for all product lines except BlueCare. Once a caller phones this number, the system will ask for information in order to route the call to the correct division or to the interacting voice response system which is used to answer general questions for providers. This number is used for both in-state and out-of-state calls. The number is 1-800-565-9140. The number for BlueCare is 1-800-543-8607.
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Q6: Who should be credentialed with BlueCross BlueShield of Tennessee?
A6: On and after May 1, 1998, applicants that meet BlueCross BlueShield of Tennessee network participation requirements must successfully complete the credentialing process prior to being accepted as a participating health care professional in any of our managed care networks and listed in any paper or electronic directory produced by BlueCross BlueShield of Tennessee. There must also be a signed agreement and/or attachment from the health care professional that has been accepted and approved by us for each managed care network.
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Q7: I’ve been told that I could no longer fax my claims to BlueCross BlueShield of Tennessee. Is that information correct?
A7: In order to assure precise control, timely and accurate payment of claims and to reduce the potential of fraud, BlueCross BlueShield of Tennessee will not accept claims faxed, photocopied or altered (exceptions require prior approval).
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BlueCare

Serves over 560,000 TennCaresm members who have selected BlueCross BlueShield of Tennessee as their managed care organization.

Q1: What number should I call for BlueCare precert?
A1: (800)246-1904 - Region 1
(800)935-4700 or (423)531-5170 - Region 2
(888)423-0131 - Region 3
(800)953-7290 - Region 4
(888)202-5901 - Region 5
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Q2: What is EPSDT and what should happen during an EPSDT checkup?
A2: "EPSDT" stands for Early and Periodic Screening, Diagnosis, and Treatment.

Check-ups must include these eight things:

  1. Questions about the child’s health in the past.
  2. A complete study of the child’s growth and development - both mental and physical. (The doctor may need to send the child to a mental health specialist for this).
  3. A complete unclothed physical exam.
  4. Eyesight checks.
  5. Hearing checks.
  6. Any shots the child needs.
  7. Lab tests, including a blood test for lead, if needed.
  8. Advice on how to keep the child healthy.

In addition to the above items, the child will be sent to a dentist when necessary.


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BlueSelect

PPO state product with a restricted network of health care providers as well as more innovative gatekeeper and point-of-service options.

Q1: What number should I call for BlueSelect precert?
A1: (800)343-7733
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BluePreferredPPO

 with a broad network of health care providers. The least restricted of our managed care products.

Q1: What number should I call for BluePreferred precert?
A1: (800)343-7733
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HMOBlue (formerly CareChoice)  

An HMO with its own network of health care providers. Individual health care needs are managed through the use of a PCP (Primary Care Physician).

Q1: If I cannot find an appropriate specialist in the HMO Blue network, what should I do?
A1:

If you have to select an out-of-network provider, we ask that you select one from the Blue Preferred Network Directory. (For a copy of the directory, contact your Provider Service representative.)

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Q2: What number should I call for HMO Blue precert?
A2:  

(800) 254-8217 or (615) 329-8044 - Mid-Tenn IPA
(615) 834-9844 - Mid-South IPA (Nashville)
(800) 228-2096 - all other areas

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SecurityBlue

Our Medicare Risk product.

Q1: What is SecurityBlue?
A1: SecurityBlue is the health maintenance organization system designed specifically for Medicare recipients. It services the Chattanooga and Knoxville areas including Hamilton, Knox, Sequatchie, McMinn, Meigs, and Loudon counties. The Health Care Financing Administration contracts with Tennessee Health Care Network, Inc. to provide SecurityBlue to those Medicare Eligibles who select it in lieu of Medicare benefits.
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Q2: What number should I call for Security Blue precert?
A2: (423)670-6740 - UT Risk Arrangement
(800)919-9213 - All other areas
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Q3: How can I obtain a SecurityBlue Provider Administration Manual?
A3: Contact your local Provider Service representative.
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WellPort

A wholly owned subsidiary of BCBST. Memorial Hospital of Chattanooga will provide the network of physicians through Memorial Health Services, a physician-hospital organization (PHO).

Q1: If I need to make changes (office hours, address, accepting/not accepting new patients, etc.), whom should I contact?
A1: If you need to make changes you should contact:

Memorial Health Services
2525 de Sales Avenue
Chattanooga, TN 37404
Fax: (615)495-7887
Phone: (615)495-7468


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Q2: What number should I call for HMO Blue precert?
A2: (800) 254-8217or (615)329-8044 - Mid-Tenn IPA
(615) 834-9844 - Mid-South IPA (Nashville)
(800) 228-2096 - all other areas
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Q3: What number should I call for Wellport precert?
A3: (800)532-2273 - all areas
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Page Modified:May 21, 2012