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Office Administration
- Apply for a Medicaid ID
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Patient Administration
- Abortion Medical Necessity Certification (English)
- Abortion Medical Necessity Certification (Spanish)
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School-Based Forms
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- Consent to Access Information - Arabic
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- Reimbursement for School-Based Services Provider Presentation
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Appeals and Reconsiderations
- Provider Appeal - Expedited
- Provider Appeal Form
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- Value-Based Payment Appeal Form
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- Value-Based Reconsideration Form
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Provider BlueCard Claim Appeal Form
Please fax the completed form to (423) 535-1959. If you choose to use this new appeal form, it must be submitted along with the standard BCBST Provider Appeal Form.
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Patient Authorizations
- Authorized Complex Rehabilitation Technology Supplier Compliance Certification
- Bariatric Surgery Authorization Request Form
- BlueCare High-Tech Imaging Prior Authorization Frequently Asked Questions
- BlueCare Tennessee/CoverKids Prior Authorization List
- BlueCare Tennessee Medical Emergency Diagnosis Code List
- Complex Rehabilitation Technology DME Authorization Request
- Durable Medical Equipment Request Form
- High-Cost Lab Prior Authorization List
- High-Tech Imaging Prior Authorization List
- Initial Member/Caregiver Training Checklist
- MCG Site Guideline Transparency
- Prior Authorization Request Form
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Forms
- Behavioral Health Out of Network Request Form
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- Psychological Testing Form
- Referral for Applied Behavioral Analysis (ABA)
- Request for Applied Behavioral Analysis (ABA)
- Same Day Notice Form (English)
- Same Day Notice Form (Spanish)
- TennCare Behavioral Health Adverse Occurrence Form
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Resources
- Applied Behavior Analysis Provider Requirements and Program Description
- Buprenorphine Medication Assisted Treatment (BMAT) Program Description
- Decision-Making Support: Empowering Patients with Intellectual and Developmental Disabilities
- IECMH Program Description
- Intellectual/Developmental Disabilities Toolkit Overview
- Naltrexone MAT Program Description
- Neonatal Abstinence Syndrome: Education Material for Medication-Assisted Treatment (MAT) Providers
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Code Edits/Code Updates
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Member Benefits Information
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Effective 5/10/2026
- Allergan Testing – G2031
- Biomarker Testing for Autoimmune Rheumatic Disease – G2022
- Diagnosis of Vaginitis – M2057
- Evaluation of Dry Eyes – G2138
- Flow Cytometry – F2019
- Helicobacter Pylori Testing – G2044
- Human Immunodeficiency Virus (HIV) – M2116
- Intracellular Micronutrient Analysis – G2099
- Lyme Disease Testing – G2143
- Onychomycosis Testing – M2172
- Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing – G2164
- Pediatric Preventive Screening – G2042
- Prenatal Screening (Nongenetic) – G2035
- Prescription Medication and Illicit Drug Testing in the Outpatient Setting – T2015
- Salivary Hormone Testing – G2120
- Thyroid Disease Testing– G2045
- Urinary Tumor Markers for Bladder Cancer – G2125
- Venous and Arterial Thrombosis Risk Testing – M2041
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Effective 3/15/2025
- Coronavirus Testing in the Outpatient Setting - G2174
- Diabetes Mellitus Testing - G2006
- Diagnosis of Idiopathic Environmental Intolerance – G2056
- Diagnostic Testing of Iron Homeostasis and Metabolism – G2011
- Immune Cell Function Assay – G2098
- Immunohistochemistry – P2018
- Laboratory Procedures Reimbursement Policy – R2162
- Testing of Homocysteine Metabolism – Related Conditions – M2141
- Testosterone – G2013
- Therapeutic Drug Monitoring for 5-Fluorouracil – M2067
- Vitamin B12 and Methylmalonic Acid Testing – G2014
- Vitamin D Testing – G2005
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Effective 6/25/2025
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Effective 4/25/2025
- Cardiovascular Disease Risk Assessment - G2050
- Cervical Cancer Screening – G2002
- Diagnostic Testing of Common Sexually Transmitted Infections – G2157
- Diagnostic Testing of Influenza – G2119
- Epithelial Cell Cytology in Breast Cancer Risk Assessment – G2059
- Fecal Analysis in the Diagnosis of Intestinal and Fecal Microbiota Transplant Testing – G2060
- Fecal Calprotectin Testing in Adults – G2061
- Flow Cytometry – F2019
- Folate Testing – G2154
- Gamma-glutamyl Transferase Testing in Adults – G2173
- General Inflammation Testing – G2155
- Hepatitis Testing – G2036
- Identification of Microorganisms Using Nucleic Acid Probes – M2097
- Immunopharmacologic Monitoring of Therapeutic Serum Antibodies – G2105
- In Vitro Chemoresistance and Chemosensitivity Assays – G2100
- Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease – G2121
- Metabolites Markers of Thiopurines Testing – G2115
- Nerve Fiber Density Testing – M2112
- Oral Cancer Screening and Testing – G2113
- Pancreatic Enzyme Testing for Acute Pancreatitis – G2153
- Pathogen Panel Testing – G2149
- Prenatal Testing (Nongenetic) – G2035
- Prostate Biopsy Specimen Analysis – G2007
- Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Disease – G2123
- Serum Testing for Evidence of Mild Traumatic Brain Injury – G2151
- Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease – G2110
- Testing for Alpha-1 Antitrypsin Deficiency – M2068
- Testing for Vector-borne Infections – G2158
- Thyroid Disease Testing – G2045
- Urine Culture Testing for Bacteria – G2156
- Venous and Arterial Thrombosis Risk Testing – M2041
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Effective 2/3/2025
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Effective 4/1/2024
- B-Hemolytic Streptococcus Testing - G2159
- Biochemical Markers of Alzheimer Disease and Dementia - G2048
- Biomarkers for Myocardial Infarction and Chronic Heart Failure - G2150
- Bone Turnover Markers Testing - G2051
- Celiac Disease Testing - G2043
- Cervical Cancer Screening - G2002
- Diagnostic Testing of Common Sexually Transmitted Infections - G2157
- Diagnostic Testing of Influenza - G2119
- Epithelial Cell Cytology in Breast Cancer Risk Assessment - G2059
- Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing - G2060
- Fecal Calprotectin Testing - G2061
- Hepatitis Testing - G2036
- Immune Cell Function Assay - G2098
- Immunopharmacologic Monitoring of Therapeutic Serum Antibodies - G2105
- In Vitro Chemoresistance and Chemosensitivity Assays - G2100
- Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease - G2121
- Measurement of Thromboxane Metabolites for ASA Resistance - G2107
- Metabolite Markers for Thiopurines Testing - G2115
- Nerve Fiber Density Testing - M2112
- Prostate Biopsy Specimen Analysis - G2007
- Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases - G2123
- Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease - G2110
- Testing for Diagnosis of Active or Latent Tuberculosis - G2063
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Effective 11/1/2023
- Allergen Testing – G2031
- B-Hemolytic Streptococcus Testing - G2159
- Biochemical Markers of Alzheimer Disease and Dementia - G2048
- Biomarker Testing for Autoimmune Rheumatic Disease - G2022
- Biomarkers for Myocardial Infarction and Chronic Heart Failure - G2150
- Bone Turnover Markers Testing - G2051
- Cardiovascular Disease Risk Assesment - G2050
- Celiac Disease Testing - G2043
- Cervical Cancer Screening - G2002
- Coronavirus Testing in the Outpatient Setting - G2174
- Diabetes Mellitus Testing - G2006
- Diagnosis of Idiopathic Environmental Intolerance - G2056
- Diagnosis of Vaginitis including Multi-target PCR Testing - M2057
- Diagnostic Testing of Common Sexually Transmitted Infections - G2157
- Diagnostic Testing of Influenza - G2119
- Diagnostic Testing of Iron Homeostasis Metabolism - G2011
- Epithelial Cell Cytology in Breast Cancer Risk Assessment - G2059
- Evaluation of Dry Eyes Testing - G2138
- Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing - G2060
- Fecal Calprotectin Testing - G2061
- Flow Cytometry - F2019
- Folate Testing - G2154
- Gamma-Glutamyl Transferase - G2173
- General Inflammation Testing - G2155
- Helicobacter Pylori Testing - G2044
- Hepatitis C Testing - G2036
- HIV Genotyping and Phenotyping - M2093
- Human Immunodeficiency Virus (HIV) - M2116
- Identification of Microorganisms Using Nucleic Acid Probes - M2097
- Immune Cell Function Assay - G2098
- Immunohistochemistry - P2018
- Immunopharmacologic Monitoring of Therapeutic Serum Antibodies - G2105
- In Vitro Chemoresistance and Chemosensitivity Assays - G2100
- Intracellular Micronutrient Analysis - G2099
- Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease - G2121
- Lyme Disease Testing - G2143
- Measurement of Thromboxane Metabolites for ASA Resistance - G2107
- Metabolite Markers for Thiopurines Testing - G2115
- Nerve Fiber Density Testing - M2112
- Onychomycosis Testing - M2172
- Oral Cancer Screening and Testing - G2113
- Pancreatic Enzyme Testing for Acute Pancreatitis - G2153
- Parathyroid Hormone Phosphorus Calcium and Magnesium Testing - G2164
- Pathogen Panel Testing - G2149
- Pediatric Preventive Screening - G2042
- Prenatal Screening-Nongenetic - G2035
- Prescription Meds and Illicit Drug Testing in the Outpatient Setting - T2015
- Prostate Biopsies - G2007
- Salivary Hormone Testing - G2120
- Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases - G2123
- Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease
- Serum Tumor Markers for Malignancies - G2124
- Testing For Alpha-1 Antitrypsin Deficiency - M2068
- Testing for Diagnosis of Active or Latent Tuberculosis - G2063
- Testing for Vector-borne Infections - G2158
- Testosterone Testing - G2013
- Thyroid Disease Testing - G2045
- Urinary Tumor Markers for Bladder Cancer - G2125
- Urine Culture Testing for Bacteria - G2156
- Venous and Arterial Thrombosis Risk Testing - M2041
- Vitamin B12 Methylmalonic Acid Testing - G2014
- Vitamin D Testing - G2005
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Effective 9/1/2023 through 11/1/2023
- Allergen Testing
- ANA/ENA Testing
- B-Hemolytic Streptococcus Testing
- Biochemical Markers of Alzheimer Disease and Dementia
- Bone Turnover Markers Testing
- Cardiac Biomarkers for Myocardial Infarction
- Cardiovascular Disease Risk Assessment
- Celiac Disease Testing
- Cervical Cancer Screening
- Coronavirus Testing in the Outpatient Setting
- Diagnosis of Idiopathic Environmental Intolerance
- Diagnosis of Vaginitis including Multi-target PCR Testing
- Diagnostic Testing of Common Sexually Transmitted Infections
- Diagnostic Testing of Influenza
- Diagnostic Testing of Iron Homeostasis Metabolism
- Epithelial Cell Cytology in Breast Cancer Risk Assessment
- Erectile Dysfunction
- Evaluation of Dry Eyes Testing
- Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing
- Fecal Calprotectin Testing in Adults
- Flow Cytometry
- Folate Testing
- Gamma-Glutamyl Transferase
- General Inflammation Testing
- Genetic Testing for Adolescent Idiopathic Scoliosis
- Helicobacter Pylori Testing
- Hemoglobin A1c
- Hepatitis C
- HIV Genotyping and Phenotyping
- Identification of Microorganisms Using Nucleic Acid Probes
- Immune Cell Function Assay
- Immunohistochemistry
- Immunopharmacologic Monitoring of Therapeutic Serum Antibodies
- In Vitro Chemoresistance and Chemosensitivity Assays
- Intracellular Micronutrient Analysis
- Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease
- Lyme Disease
- Measurement of Thromboxane Metabolites for ASA Resistance
- Metabolite Markers of Thiopurines Testing
- Nerve Fiber Density Testing
- Onychomycosis Testing
- Oral Screening Lesion Identification Systems and Genetic Screening
- Pancreatic Enzyme Testing for Acute Pancreatitis
- Parathyroid Hormone Phosphorus Calcium and Magnesium Testing
- Pathogen Panel Testing
- Pediatric Preventive Screening
- Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection
- Prenatal Screening-Nongenetic
- Prescription Medication and Illicit Drug Testing in Outpatient Setting
- Prostate Biopsies
- Salivary Hormone Testing
- Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases
- Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease
- Serum Tumor Markers for Malignancies
- ST2 Assay for Chronic Heart Failure
- Testing For Alpha-1 Antitrypsin Deficiency
- Testing for Diagnosis of Active or Latent Tuberculosis
- Testing for Mosquito or Tick Related Infections
- Testosterone Testing
- Thyroid Disease Testing
- Urinary Tumor Markers for Bladder Cancer
- Urine Culture Testing for Bacteria
- Venous and Arterial Thrombosis Risk Testing
- Vetra DA Blood Test for Rheumatoid Arthritis
- Vitamin B12 Methylmalonic Acid Testing
- Vitamin D Testing
- Zika Virus Risk Assessment
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Guidelines
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Manuals
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Aligned Death Review Process
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CHOICES
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Community Living Supports
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ECF CHOICES
- Employment and Community First (ECF) CHOICES Benefit Table
- ECF CHOICES Employment Services Provider Guide
- Employment Services Provider User Guide
ECF CHOICES Report Templates
- Benefits Counseling
- Career Advancement
- Discovery
- Exploration
- Job Coaching Fading Plan
- Job Development Plan
- Self-Employment Plan
- Situational Observation and Assessment
- Employment Service Template (used for JDSU, SESU, Career Advancement and Small Group incentive payment)
- Employee Placement
- Service Log Form
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Reportable Event Management
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Workforce Development
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Detailed Business Requirements
2026
- Acute Diabetes Exacerbation Episode
- Acute Gastroenteritis Episode
- Acute Kidney and Ureter Stones Episode
- Acute Percutaneous Coronary Intervention Episode
- Acute Seizure Episode
- Appendectomy Episode
- Asthma Acute Exacerbation Episode
- Attention Deficit Hyperactivity Disorder Episode
- Back/Neck Pain Episode
- Bariatric Surgery Episode
- Breast Biopsy Episode
- Bronchiolitis Episode
- Colposcopy Episode
- Congestive Heart Failure Acute Exacerbation Episode
- COPD Acute Exacerbation Episode
- Coronary Artery Bypass Graft CABG Episode
- Cystourethroscopy Episode
- Esophagogastroduodenoscopy EGD Episode
- Femur/Pelvis Fracture Episode
- Gastrointestinal GI Obstruction Episode
- Gastrointestinal Hemorrhage Episode
- Heart Valve Replacement or Repair Valve Episode
- Hernia Repair Episode
- Human Immunodeficiency Virus HIV Infection Episode
- Hysterectomy Episode
- Inpatient Urinary Tract Infection Episode
- Knee Arthroscopy Episode
- Non-acute Percutaneous Coronary Intervention PCI Episode
- Non-operative Ankle Injury Episode
- Non-operative Knee Injury Episode
- Non-operative Shoulder Injury Episode
- Non-operative Wrist Injury Episode
- Oppositional Defiance Disorder Episode
- Otitis Media Episode
- Outpatient and Non-acute Inpatient Cholecystectomy Episode
- Outpatient Urinary Tract Infection Episode
- Pancreatitis Episode
- Pediatric Pneumonia Episode
- Perinatal Episode
- Pneumonia Episode
- Respiratory Infection Episode
- Screening and Surveillance Colonoscopy Episode
- Skin and Soft Tissue Infections Episode
- Spinal Decompression Without Fusion Episode
- Spinal Fusion Episode
- Syncope Work-up Episode
- Tonsillectomy Episode
- Total Joint Replacement TJR Episode
2025
- Acute Diabetes Exacerbation Episode
- Acute Gastroenteritis Episode
- Acute Kidney and Ureter Stones Episode
- Acute Percutaneous Coronary Intervention Episode
- Acute Seizure Episode
- Appendectomy Episode
- Asthma Acute Exacerbation Episode
- Attention Deficit Hyperactivity Disorder Episode
- Back/Neck Pain Episode
- Bariatric Surgery Episode
- Breast Biopsy Episode
- Bronchiolitis Episode
- Colposcopy Episode
- Congestive Heart Failure Acute Exacerbation Episode
- COPD Acute Exacerbation Episode
- Coronary Artery Bypass Graft CABG Episode
- Cystourethroscopy Episode
- Esophagogastroduodenoscopy EGD Episode
- Femur/Pelvis Fracture Episode
- Gastrointestinal GI Obstruction Episode
- Gastrointestinal Hemorrhage Episode
- Heart Valve Replacement or Repair Valve Episode
- Hernia Repair Episode
- Human Immunodeficiency Virus HIV Infection Episode
- Hysterectomy Episode
- Inpatient Urinary Tract Infection Episode
- Knee Arthroscopy Episode
- Non-acute Percutaneous Coronary Intervention PCI Episode
- Non-operative Ankle Injury Episode
- Non-operative Knee Injury Episode
- Non-operative Shoulder Injury Episode
- Non-operative Wrist Injury Episode
- Oppositional Defiance Disorder Episode
- Otitis Media Episode
- Outpatient and Non-acute Inpatient Cholecystectomy Episode
- Outpatient Urinary Tract Infection Episode
- Pancreatitis Episode
- Pediatric Pneumonia Episode
- Perinatal Episode
- Pneumonia Episode
- Respiratory Infection Episode
- Screening and Surveillance Colonoscopy Episode
- Skin and Soft Tissue Infections Episode
- Spinal Decompression Without Fusion Episode
- Spinal Fusion Episode
- Syncope Work-up Episode
- Tonsillectomy Episode
- Total Joint Replacement TJR Episode
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Episodes of Care
- 2024 Episodes of Care Thresholds
- 2025 Episodes of Care Thresholds
- 2024 Episodes of Care Risk Factors
- 2024 Gainsharing Limits
- 2025 Gainsharing Limits
- Division of TennCare Episodes of Care Resources
- Episodes of Care Risk Adjustment Methodology
- TennCare Memo: 2023 Episode Changes
- TennCare Memo: 2024 Episode Changes
- THCII Episodes of Care Provider FAQ
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Other Quality Documents
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Value-Based Payment Appeal and Reconsideration Forms
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Early and Periodic Screening, Diagnostic and Treatment/Well-Child Care
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Home Health
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Maternity Care
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Sickle Cell Disease
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Cultural Competency Resources
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Deficit Reduction Act
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Memos
- Grace Period for Reimbursement of Oral Medication Administration
- June 19, 2018 Budget Memo Attachment - DMEPOS April 2018 Fee Schedule for July 2018
- MCO Budget Reduction Notice, Oct. 2021
- MCO Budget Reduction Notice - June 19, 2018
- Provider Satisfaction Survey Announcement
- TennCare Memo: Stand-alone Vaccine Counseling
- TennCare Memo: Updates Expanding TennCare Buprenorphine Dosage Limits used for Medication Assisted Treatment
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Resources
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Announcements & Notices
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Archive
BlueAlert Newsletters
- December 2025 BlueAlert
- November 2025 BlueAlert
- October 2025 BlueAlert
- September 2025 BlueAlert
- August 2025 BlueAlert
- July 2025 BlueAlert
- June 2025 BlueAlert
- May 2025 BlueAlert
- April 2025 BlueAlert
- March 2025 BlueAlert
- February 2025 BlueAlert
- January 2025 BlueAlert
- BlueAlert Addendum: January 2025
- December 2024 BlueAlert
- November 2024 BlueAlert
- October 2024 BlueAlert
- September 2024 BlueAlert
- August 2024 BlueAlert
- July 2024 BlueAlert
- June 2024 BlueAlert
- May 2024 BlueAlert
- April 2024 BlueAlert
- March 2024 BlueAlert
- February 2024 BlueAlert
- January 2024 BlueAlert
- December 2023 BlueAlert
- November 2023 BlueAlert
- October 2023 BlueAlert
- September 2023 BlueAlert
- August 2023 BlueAlert
- July 2023 BlueAlert
- June 2023 BlueAlert
- May 2023 BlueAlert
- April 2023 BlueAlert
- March 2023 BlueAlert
- February 2023 BlueAlert
- January 2023 BlueAlert
Code Edits/Code Updates
- Code Editing for Facility High Level Emergency Room Services (July 1, 2024)
- Office and Outpatient Evaluation and Management Visit Complexity Add-on Payment Code G2211 (Effective Jan. 1, 2024)
- Ophthalmology Policies (Effective June 15, 2022)
LTSS Newsletter
- Quarter 4 2024 LTSS Newsletter
- Quarter 3 2024 LTSS Newsletter
- Quarter 2 2024 LTSS Newsletter
- Quarter 1 2024 LTSS Newsletter
Quality Care Quarterly Newsletter
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BlueAlert Provider Newsletter
2026 BlueAlert Newsletter
- April BlueAlert
- March BlueAlert
- February BlueAlert
- January BlueAlert
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Division of TennCare Announcements
2025 Division of TennCare Announcements
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Quality Care Quarterly Newsletter
2025 Quality Care Newsletter
2024 Quality Care Newsletter
2023 Quality Care Newsletter
2022 Quality Care Newsletter
2021 Quality Care Newsletter
2020 Quality Care Newsletter
2019 Quality Care Newsletter
2018 Quality Care Newsletter
2017 Quality Care Newsletter
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LTSS Newsletter
2026 LTSS Newsletter
2025 LTSS Newsletter
Looking for more information about LTSS programs?
Find information about caring for members enrolled in CHOICES, ECF CHOICES and other LTSS programs.