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.
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.
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
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.
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.
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).
Check-ups must include these eight things:
In addition to the above items, the child will be sent to a dentist when necessary.
PPO state product with a restricted network of health care providers as well as more innovative gatekeeper and point-of-service options.
with a broad network of health care providers. The least restricted of our managed care products.
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).
|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.)|
|(800) 254-8217 or (615) 329-8044 - Mid-Tenn IPA
(615) 834-9844 - Mid-South IPA (Nashville)
(800) 228-2096 - all other areas
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.
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).
Memorial Health Services
2525 de Sales Avenue
Chattanooga, TN 37404