State of TN Public Sector Health Plans

Outpatient authorization requirements

STATE OF TENNESSEE PUBLIC SECTOR PLAN OUTPATIENT AUTH REQUIREMENTS Effective Jan. 1, 2011, all outpatient invasive procedures are required to have prior authorization.  This does not apply to procedures performed in an office setting.  The requirement applies to all State of Tennessee commercial members with the following member ID prefixes:

• STA – State Employees
• STT – Local Education Employees
• STG – Local Government Employees
• STL – Local Government PPO-Limited Plan Employees

Network Change

The State has sponsored three Public Sector Plan options, which include a Standard PPO, Partnership PPO and PPO-Limited plan. For more information on these plan options, visit http://www.partnersforhealthtn.gov/. For the State-sponsored plans, members should use providers participating in Blue Network S.

Preventive Care Benefits

The State Public Sector Plans provide 100 percent coverage for preventive care services when received by a Network S provider. Contact BlueCross if you have questions about specific preventive care benefits for State of Tennessee Public Sector Plan members.

State Member Identification Card

Want to view the State member ID card?

• Limited PPO 
• Partnership PPO 
• Standard PPO 

State Member Web Page

BlueCross has created a web page specifically for State of Tennessee Public Sector Plan members. This page provides members with information related to their state-sponsored health plans. To view the member page, go to www.bcbst.com/members/tn_state.

Advanced Radiological Imaging Services

For State of Tennessee Public Sector Plan members, BlueCross will review certain non-routine diagnostic services and the setting for such services in regards to medical necessity and appropriateness before the services are performed. Services subject to such review include, but are not limited to, Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Magnetic Resonance Spectroscopy (MRS), Computerized Tomography (CT), Computerized Tomography Angiography (CTA), Positron Emission Tomograpy (PET) scans and nuclear cardiac imaging studies. Physicians should authorize Advanced Radiological Imaging services before providing the service to the member. Prior authorization information is located on the back of the member identification card.