Our goal is to provide quality health information on the BlueCross BlueShield of Tennessee Web site while respecting your rights for privacy and informed use of the site. With this in mind, we would like to explain how this site works and how we obtain its content. While we are committed to quality content, we do not intend for information on the site to act as a substitute for health care or medical advice from a professional. All questions about individual care or treatment should be referred to your health care provider.
Code of Conduct
BlueCross BlueShield of Tennessee has a formal Code of Conduct policy that includes a conflict of interest section, and establishes guidelines, principles, and ethics by which all staff members, including those contributing to the site, must abide. Staff members are also required to review and to complete a training course on these policies annually. Contractors must sign a confidentiality agreement and, just like employees, must annually complete the Corporate Code of Conduct training program. Contractors and third parties are subject to BCBST standards for design, security, quality and compliance with government and industry requirements. For more details, see the online version of our Code of Conduct.
Conflict of Interest
BlueCross BlueShield of Tennessee is dedicated to bringing you unbiased, quality content on this site. Business relationships with a third party that could jeopardize the objectiveness of data or content will be stated on the site. Internal staff must avoid financial or other interests in any entity perceived to have an influence on the integrity of site content. Content is reviewed and approved at several levels in the publishing process.
At least once a year the BCBST Compliance Department distributes a conflict of interest questionnaire to all employees based upon their particular job duties. Persons who receive the questionnaire must answer all questions fully and accurately, must certify as to the accuracy of the information given, and update that information whenever necessary.
Any potential conflicts of interest must be disclosed to the employee's supervisor at the time of hire or at the time that the financial or other interest develops. The supervisor will determine whether a conflict exists and, if so, what actions should be taken to eliminate or avoid the conflict.
BlueCross BlueShield of Tennessee is a not-for-profit independent licensee of the BlueCross BlueShield Association. BCBST maintains editorial independence and requires a separation between editorial and commercial interests.
Proprietary Online Services
- BlueAccess and member self-service gives you the ability to verify benefits, including eligibility and coverage details, check medical, behavioral health and dental claim status (excludes prescription drug claims), look up prior authorization status, order replacement ID cards* and includes other online services for employers, brokers and providers. When you choose to register with BlueAccess, we will ask you for your subscriber ID, date of birth and group number. We will then mail a PIN number to you at the address we have on file. After you receive your PIN number, you may register and choose an ID and password. After first use of BlueAccess, you will receive a letter mailed to your address on file confirming that you have accessed the service.
*may not be available to all subscribers
- Individuals can enroll in an insurance plan online using the Individual Sales Online Application. We will collect certain information from you that is necessary for us to be able to offer you the insurance policy you have requested. After application, we will give you online confirmation that we have received your application followed by a letter of confirmation. You may also receive a follow-up phone call or e-mail.
- Correspondence sent to us via our Online Contact Form is sent securely. We will respond to requests via e-mail, phone call or letter, whichever is requested or most appropriate considering the nature of the data to be transmitted.
- WalkingWorks is a fitness program that helps you start and maintain a regular walking routine. WalkingWorks has tools, tips and resources to educate and encourage walkers. Most of the information is public, but members must register and log in to use the walking log. The walking log allows you to record distances walked so you can track your progress. For members, the registration process is the same as BlueAccess above, since WalkingWorks is offered to members who have a BlueAccess login. Non-members will be asked name, address and e-mail address. When you choose to sign in to create your account, you will be asked your weight in order to determine number of calories burned. This information is strictly used in this application and for this purpose.
The services above are secure services that will require you to submit personally identifiable information. For the sales application, you may be required to submit personal health information for underwriting purposes.
- BlueWizard online quote program allows brokers to get quotes on groups of up to 150 via the Internet. It contains benefits, quotes, client data and census information and offers instant electronic renewal packages for increased consistency. In BlueWizard, brokers enter group information (group name, size, address, phone number, and SIC code), as well as census data that represents all employees in the group (DOB, gender, and type contract). Employee data is unidentifiable and no protected health information (PHI) is captured by the program.
BlueCross BlueShield of Tennessee has formed strategic partnerships to deliver to visitors of our site a wide variety of high quality heath content and services. Partners are subject to BCBST's standards for design, security, quality and compliance with government and industry requirements, which were agreed to at the time of contract. BlueCross BlueShield of Tennessee does not monitor or review the health content on these sites. Each site has its own editorial staff and editorial review process. You should read the editorial review policies of these sites to understand how these sites handle their content review.
- American WholeHealth Networks, Inc.
- Caremark PCS, Inc.
- Onlife Health, Inc.
A wholly-owned subsidiary of BlueCross BlueShield of Tennessee, Onlife Health is a national population health management company based in Nashville, Tennessee. The company offers a comprehensive suite of products and services. Onlife Health works with employers, health plans and hospital’s to identify, control and manage health risk factors and their associated costs. Through targeted and tailored programs, and sophisticated tracking, monitoring and reporting capabilities, Onlife Health works with clients to measure program progress and cost savings. Onlife Health maintains the Personal Health Analysis and Personal Health Manager tools on this site. Onlife Health, Inc. agrees to notify you of what personally identifiable information is collected from you through the Web site, the organization collecting the information, how the information is used and with whom it is shared. They will also inform you of your choices regarding collection, use and distribution of the information; security procedures in place to protect the loss, misuse or alteration of your information; and how you can correct any inaccuracies in the information. For more information, see their Code of Conduct and Terms.
- Shared Health, Inc.
A wholly-owned subsidiary of BlueCross BlueShield of Tennessee, Shared Healthy, Inc. offers secure, innovative health information technology (Health IT) solutions. Today, Shared Health is the largest public/private data sharing initiative of its kind in the United States. In addition to providing Health IT solutions to government payers, Shared Health is also branching into commercial payer markets. Shared Health's core solutions - the Shared Health ePrescribe and the Shared Health (CHR) Consumer View - provide greater accuracy, increased safety and efficiency, and ultimately, more effective patient treatment and outcomes. Additionally, the CHR - Consumer View offers consumers access to the CHR, supporting the trend of increasing consumer responsibility and empowering consumers to access their own information about their own health care. Shared Health, Inc. agrees to notify you of what personally identifiable information is collected from you through the Web site, the organization collecting the information, how the information is used and with whom it is shared. They will also inform you of your choices regarding collection, use and distribution of the information; security procedures in place to protect the loss, misuse or alteration of your information; and how you can correct any inaccuracies in the information. For more information, see their Privacy Statement and Site Usage.
It is the policy of BlueCross BlueShield of Tennessee to present information to all users of the site in language that is clear, easily read and easily understood and to comply with all state and federal regulations which may apply to those communications.
Content Selection Criteria
Content on this site is submitted to a rigorous, multi-layered approval process. The material is reviewed to ensure that it meets the following criteria:
- appropriate for the general public or the specific external audience
- meets legal, security and brand requirements
- written and formatted to be most effective as an electronic communication tool
Original health content must meet the following additional criteria:
- Evidence-Based MedicineTopics based on the use of current best available external clinical evidence in making decisions about patient care.
- Clinical SignificanceMedical findings published in peer-reviewed medical journals.
- RelevanceNews and topics that may affect your health and your health care choices.
- TrendsHealth issues currently in the news or a matter of public health awareness; community practice standards.
Health Content Approval and Sources
To ensure the highest quality of health content possible, all health content goes through a special approval process before it is published on the site. Dr. Rich Cassidy, Chief Medical Officer, has clinical oversight responsibility for the health content approval process.
- Jaberta Evans - Corporate Communications
- Inga Himelright, MD - Associate Chief Medical Officer
- Deborah Webb, MD Medical Director Government Medical Management
- Dan Barnett, MD Medical Director, Medical Risk Management
- John Wright, MD - Chair Regional Medical Director (Middle)
- Robert Yates, MD Regional Medical Director (West)
- Betty Emmert, RN Medical Policy Research Consultant
This site contains two types of health content: 1) proprietary information created by internal staff at BlueCross BlueShield of Tennessee and 2) licensed content from an external source.
- Internal authors - Internal staff approving and editing content must be an employee of the company in the areas of Health Care Services, Provider Networks and Contracting, or Communications and meet a minimum of two of the following criteria: 1) College graduate, 2) Manager level or above, or 3) three to five years clinical experience.
- External authors - The Web site does not usually publish unsolicited content; however, in the event that an author outside of the company provides an outline of proposed content for consideration, the Web site editorial process will review the content for publication.
- Unsolicited content will not be returned and decisions not to publish will not be communicated to the author.
- For solicited content, external authors must include education and experience with their submissions, and their credentials will be evaluated by our internal review process. Minimum qualifications will be determined per submission, and the author's credentials will be stated on the site.
Sources of health content are verified and stated on the site. Where health content is based on clinical experience or scholarly research, the actual author of the content will be stated. The credentials of the author will be placed on the Web site following the content, along with the author’s name and date. Any health professionals interacting with users on the site must meet credentials requirements.
Any self-assessment tool on the site will include proper documentation, such as the source, scientific basis for its operation, how the tool is maintained on the site, and the date of last update or review, all of which will be stated on the site.
All claims of therapeutic benefit stated on the site must go through this review process before appearing on the site in order to ensure that there is a reasonable basis for these claims. Ads or sponsored health content programs will go through a review process to show that the site is not accepting false or misleading information or promoting ineffective or dangerous products.
All content is reviewed at least annually. Outdated content is updated or removed from the site.
The medication formulary represents safe, cost-effective drugs expected to produce desired goals of therapy at a reasonable cost. It is:
- developed and maintained based on sound clinical evidence
- developed and reviewed with recommendations from actively practicing physicians and pharmacists
- reviewed annually and updated as needed
- distributed to practitioners annually in its entirety, with updates via print or electronic means
Members are informed of the:
- existence of the formulary information
- steps to obtain the formulary information
- process to appeal denials of non-covered drugs
The BlueCross BlueShield Pharmacy and Therapeutics (P&T) Committee considers FDA-approved drugs for inclusion in the formulary. The P&T Committee consists of pharmacists and physicians, some of whom are community practitioners. The evaluation includes a literature review, and expert opinion may be sought. Formal reviews are prepared and typically address the following information: Effectiveness, safety, comparison studies, approved indications, adverse effects, contraindications, pharmacokinetics, patient administration/compliance considerations, medical outcome and pharmacoeconomic studies, and cost.
When a new drug is considered for formulary inclusion, an attempt will be made to examine the drug relative to similar drugs currently on formulary. Drugs reviewed by the P&T Committee are typically assigned to either Tier 2 or Tier 3, considering cost and clinical usefulness of the product. In addition, entire therapeutic classes are periodically reviewed. The class review process may result in a tier change for a specific drug.
The decisions of the P&T Committee may be communicated after each meeting in the provider newsletter BlueAlert, specialized mailings, or on www.bcbst.com. Pharmacy Management oversees the printing of the medication formulary and Prescribing Guidelines.
Review of the medication formulary occurs no less than annually and when new medical information becomes available. Drug classification, availability, and tier placement are subject to change. All of the material on the site related to the formulary is provided as a reference for drug therapy selection. The final choice of specific drug selection for an individual member rests solely with the prescriber.
BlueCross BlueShield of Tennessee currently does not accept advertisements from outside entities on its site. Any future advertising placed on the site would be distinguishable from health content either by words or by design. Any financial relationships with a linked site, including in-kind services other than reciprocal linking, will be stated and described on the site.
We encourage feedback from users of our site. A feedback form is available in the Contact Us [UT04]section of the site for you to make suggestions or comments about your experience with the site that we will utilize for site evaluation purposes and for planning future improvements and functionality.