PROVIDER ADMINISTRATION MANUALS
View our Provider Administration Manuals
As discussed in our provider contracts, these manuals are your source for important information about our policies and procedures.
We’ve dedicated a COVID-19 Provider FAQ at BCBSTupdates.com for temporary policy changes related to claims, coding, enrollment and other policy changes during the COVID-19 emergency. That FAQ takes precedence over any information that may conflict with information in our current PAMs during this COVID-19 emergency. Please contact your network manager if you have questions.
Please note, the updated PAMs are effective on the first day of the new quarter. Effective dates are as below:
Quarter 1: Jan. 1
Quarter 2: April 1
Quarter 3: July 1
Quarter 4: Oct. 1
Commercial PAM (Preview Edition Effective January 1, 2025)
Commercial Provider Administration Manual (including Medicare Advantage)
BlueCare Tennessee Provider Administration Manual
BlueCare Tennessee Provider MLTSS Manual
BlueCare Tennessee Community Living Supports Manual for CHOICES and ECF CHOICES
BlueCare Plus (HMO SNP)℠ Provider Administration Manual
Medical Policies
Utilization Management Guidelines
Administrative Services Policies
BlueCross BlueShield of Tennessee Clinical Practice Guidelines
BlueCross adopts and disseminates specific nationally recognized clinical practice guidelines for use by our network providers. The guidelines address acute and chronic medical services, and behavioral health services to assist Practitioners in making appropriate health care decisions for specific clinical circumstances. It’s our intent to make resources available to our providers that will help in this endeavor. BlueCross attests that the text and format of these compendia have not been altered in any way, and that these resources should not be construed as a legal or required standard of care.
More information can be found in the U.S. Preventive Services Task Force Guide to Clinical Preventive Services. We hope this will be both convenient and helpful to you in caring for your patients. Paper copies of the guidelines are available upon request by calling (423) 535-6705(423) 535-6705.
