BlueCare Tennessee (including TennCareSelect), run by BlueCross BlueShield of Tennessee, administers the TennCare ABA benefit under the shared tri-MCO program description — so the clinical rules match the TennCare baseline exactly. What's BlueCare-specific is the machinery: Availity submission, BlueCare's own supplemental initiation/continuation form, dedicated fax lines, and a 7-day standard UM clock.
Submissions run through Availity (or via provider.bcbst.com), with fax as the fallback — (800) 292-5311 for BlueCare/TennCareSelect and (800) 851-2491 for CoverKids. The assessment PA uses the universal tri-MCO request form with the diagnostic report and doctor's order attached; treatment requests add BlueCare's supplemental "Initiation and Continuation of ABA Therapy" form (rev. 2/26), which asks for the diagnosis with severity level (1–3), measurable progress, requested hours per week per code, and — at continuation — whether progress would hold if hours were reduced. UM questions go to the in-house behavioral team (BHABA@bcbst.com or (423) 535-5717, option 2).[4][5]
Authorized ABA hours are not inclusive of other services — the form explicitly separates OT/PT — so map the family's full therapy schedule without fear of crowding out the ABA request. Standard (non-urgent) authorization decisions are due within 7 calendar days: BlueCare's October 2026 manual commits to "State-established timeframes that may not exceed 7 calendar days following the receipt of the request for service" (expedited: "no later than 72 hours"), matching the TennCare contract's 7-day rule effective January 1, 2026. That is the number to set family expectations against. The older tri-MCO overview (Sept 2024) quoted 14 days; retrospective reviews it put at 30. And like all TennCare MCOs, continuation requests must account for authorized-versus-used hours, making honest availability capture at intake a six-months-later safeguard.[1][13][6]
Telehealth: yes, for every ABA code, subject to the authorization. Since October 1, 2024 BlueCare pays telehealth only for codes on its Telehealth Approved Code List, and the list updated March 10, 2026 carries 97151 through 97158, 0362T and 0373T as approved for both POS 02 (telehealth outside the home) and POS 10 (telehealth in the home). Bill the POS code; modifiers such as 95 and GT are informational only. The hours still have to be requested as telehealth, code by code, on the universal request form.[2][1][3][5]
Fee schedule: there is no public one for ABA. TennCare publishes no ABA rate table, and BlueCare pays under the fee schedule in your BlueCare provider agreement — its telehealth guide says payment for many telehealth services "will be consistent with your BlueCare Tennessee fee schedule," with a 15% reduction only on audio-only codes. For rates, go to your contract or BlueCare network management. If the family's card is a commercial BlueCross BlueShield of Tennessee plan rather than BlueCare, see the BlueCross BlueShield of Tennessee (commercial) guide.[2][1][3][5]
BlueCare Tennessee, which runs both BlueCare and TennCareSelect, does not run an any-willing-provider network. Its Provider Administration Manual says its "ability to credential Providers as well as maintain a separate network and not include any willing Provider is not considered discrimination." Network need is a recognized reason to turn an applicant down: providers "denied participation in a BCBST/BCT network for reason other than network need may not reapply for participation for a least one year." So a denial for network need does not trigger that one-year wait.[1][8]
To apply, practitioners and organizations submit a credentialing application, assessed against NCQA, CMS and TennCare Contractor Risk Agreement standards. ABA groups also have to attest to the shared TennCare ABA program description to join the ABA network. BlueCare publishes no statement on whether it is adding ABA providers in a given region; ask BlueCare provider network operations.[1][8]
BlueCare’s own manual (rev. October 1, 2026) applies the 120 days: “Contracted and non-contracted Providers must submit all claims for medical services… within 120 days of the date of service… or within 60 days from the date of the original rejection notice, whichever is later,” and corrected bills must be received within 120 days of the original BlueCare remittance. “If BlueCare Tennessee is secondary to a commercial insurer or Medicare, claims must be submitted and received within 120 days from the date the primary insurer’s remittance was produced.” A claim that was returned or rejected goes back as a new claim, not a corrected bill; only adjudicated claims are corrected. Taxonomy: “Professional claims need a taxonomy code to be submitted for the billing and rendering NPIs,” and both must match the taxonomy codes BlueCare has on file. Besides BlueCare’s internal dispute process, providers may ask the Commissioner of Commerce and Insurance for independent review under Tenn. Code Ann. 56-32-126.[1][13]
TennCare’s contract with its MCOs sets the floor for every claim: a provider has “one hundred twenty (120) calendar days from the date of rendering a covered service to file a claim,” with the clock starting later for coordination-of-benefits cases and retroactive enrollment (CRA 2.12.9.28, 2.22.4.9); the MCO must pay 90% of clean claims within 30 calendar days of receipt and process 99.5% of all claims within 60 calendar days (2.22.4.2–2.22.4.3, under Tenn. Code Ann. 56-32-126). A provider who disputes a claim decision may use the TennCare Provider Independent Review of Disputed Claims process through the Tennessee Department of Commerce and Insurance (Tenn. Code Ann. 56-32-126(b)); an overturned claim must be paid within 20 calendar days of the decision (2.22.5.2). Resubmissions: the contract gives providers at least “sixty (60) days from the date of initial notice of an invalid and/or insufficient claim or one hundred twenty (120) days from the date of service, whichever is later,” to file a valid, complete claim (2.22.4.11.3), and a paid claim that needs correcting goes in as an adjustment “within 120 days of the date of payment notification” (2.22.4.11.4). With coordination of benefits, the filing clock begins on the date the third party documented resolution of the claim (2.22.4.9). Payment cycle: each MCO “shall run one (1) provider payment cycle per week, on the same day each week, as determined by the CONTRACTOR and approved in writing by TENNCARE” (A.2.22.13); the contract does not name the day or any submission cutoff, so ask the plan which day its check run closes.[1][13]
EVV does not apply to ABA. The TennCare contract requires an electronic visit verification system for personal care and home health services that require an in-home visit, as the 21st Century Cures Act requires (CRA 2.9.17.1); ABA is neither.[1][13]
No CPR or first-aid certificate is required for BCBAs or technicians in TennCare ABA. The shared TennCare MCO ABA Program Description asks for current BCBA certification with MCO credential verification, a Tennessee Licensed Behavior Analyst licence for the analyst, BACB-compliant RBTs, and a Crisis/Emergency Plan “in accordance with BACB best practices”; it names no CPR or first-aid training. Tennessee’s behavior-analyst licensing rules (1180-05) carry none either. The only CPR and first-aid requirement in the TennCare MCO contract is for workers hired through consumer direction in CHOICES and ECF CHOICES (CRA 2.9.8.7.7), not ABA staff. An employer or the setting (a school or day program) can still require it.[10][11][13]
Graphs are required. The universal ABA request form that BlueCare uses tells providers to “attach cumulative graphs/charts of baseline data and current progress; current behavioral support plan and treatment plan including symptoms and behaviors requiring treatment, skills to be addressed, baseline measures and current progress, along with a proposed schedule of services,” including the goals achieved within the authorization period and any barriers. The shared program description lists the same “cumulative graphs/charts of baseline data and current progress” among its treatment-plan expectations, wants functioning re-measured “via standardized tools at least every two years,” and says the treatment plan “should be dated within 30 days of start date.” Neither document sets a separate data-recency window. Codes: the form's code rows are CPT 97151 through 97158 (with practitioner level noted, such as “97153 BA or RBT”); neither document lists a HCPCS H-code such as H0031 or H0032 for ABA.[5][8]
The questions that decide whether a family can start with BlueCare Tennessee (BCBST), and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the TennCare rule: EPSDT covers “children from birth through age 20 who have TennCare,” and the shared tri-MCO program description adds no age floor or ceiling of its own. BlueCare publishes no deviating age rule — its own initiation/continuation form collects date of birth without an age gate.[7][8][4]
Follows the TennCare rule: no recency limit on the ASD diagnosis itself, with functional re-evaluation by standardized tools expected “at least every two years.” BlueCare’s own forms ask for “Initial/First Date ASD Diagnosed” and for diagnostic confirmation — “diagnostic reports, doctor’s orders, etc.” — plus the DSM severity level (Level 1/2/3), but set no maximum age on the report. Continuation requests are due at least once every six months.[8][4][9]
Follows the TennCare rule: the diagnosis must be issued by “a qualified health professional, practicing within their scope, with training in assessment of individuals with ASD and/or other neurodevelopmental concerns,” with a TN-licensed clinician documenting medical necessity. BlueCare’s forms ask only for diagnostic confirmation and severity level and name no additional credential of their own.[8][9]
Follows the TennCare rule — no named instrument is required; the diagnosis must be validated by a documented comprehensive assessment against DSM-5-TR criteria, and the ABA assessment must include direct observation, file review, informant interviews and standardized assessments across cognition, communication, social, adaptive and behavioral domains. BlueCare adds a severity checkbox (Level 1/2/3) and, at continuation, asks for measurable goals and evidence of progress rather than a named test battery.[8][4][9]
Follows the TennCare rule: the assessment request needs the diagnostic report and a doctor’s order. Both BlueCare forms ask for “diagnostic confirmation like diagnostic reports, doctor’s orders, etc.” BlueCare-specific mechanics: submit through Availity (Tennessee providers) or Cohere (out-of-state), with fax fallback to (800) 292-5311 for BlueCare/TennCareSelect and (800) 851-2491 for CoverKids; UM questions go to BHABA@bcbst.com or (423) 535-5717, option 2. No referral validity window is published.[9][4][5]
Two layers, both published. Authorization: telehealth hours are requested per code on the universal tri-MCO form, which carries an “Indicate if Hours are telehealth” checkbox on every ABA code row and lists Telehealth among the places of service; the shared program description adds its cautions on clinical appropriateness, HIPAA-compliant technology and provider competence. Claims: since October 1, 2024 BlueCare pays telehealth only for codes on its Telehealth Approved Code List, and the current list (updated 3-10-26) marks every ABA code — 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T — “Yes” for both POS 02 and POS 10. The manual says telehealth modifiers such as GT and 95 are “for informational purposes” but claims “must be billed with the correct place of services (POS) 10: Telehealth Provided in Patient’s Home or POS 02: Telehealth Provider Other than in Patient’s Home.” Payment for many telehealth services “will be consistent with your BlueCare Tennessee fee schedule”; the 15% reduction applies only to audio-only codes.[2][1][3][5][8]
BlueCare's July 2026 manual: for a standard request, BlueCare "will provide notice as expeditiously as the member's condition requests and within State-established timeframes that may not exceed 7 calendar days following the receipt of the request for service." It may add "up to 14 additional calendar days" if the member or provider asks, or if BlueCare justifies needing more information. Expedited requests are decided "no later than 72 hours after the receipt of the request for service." That 72 hours can also stretch by up to 14 days on the same grounds. The clock runs from receipt. BlueCare's ABA form says continuation requests "must be submitted at least once every six months" (26-week periods) but sets no lead time before expiry.[1][13][4]
BlueCare, TennCareSelect and CoverKids "are always the payers of last resort." Bill the commercial plan first. The secondary claim must carry "the primary payer's explanation of benefits" and must be "received within 120 days from the date the primary insurer's remittance was produced." BlueCare pays only the gap up to its own allowed amount: if the other carrier paid at or above BlueCare's allowable, "BCT will make no additional reimbursement." Pay-and-chase exception: claims for "TennCare Kids," "Preventive pediatric care," all CoverKids members under 21, and absent-parent insurance "will not be denied for a primary carrier's EOB." BlueCare pays and recovers from the other plan, though the manual notes billing the other carrier first earns "the higher reimbursement rate." The manual does not say whether an ABA claim counts as "TennCare Kids." It also says to seek the primary insurer's prior authorization first only when BlueCare is secondary to Medicare. It is silent on a commercial primary. The TennCare contract lets the MCO deny a claim the primary denied for "failure to obtain prior authorization." Get the commercial PA, and confirm with BlueCare whether its own ABA PA is still needed. TRICARE by statute pays only after other coverage "except in the case of a plan administered under title XIX" (Medicaid), so TRICARE goes before TennCare. CHAMPVA is the reverse: "If you are eligible under Medicaid, CHAMPVA will pay first."[1][13][14][15]
Ask the plan: BlueCare Provider Service / UM (Availity) — ask whether an ABA claim for a member under 21 falls under the "TennCare Kids" pay-and-chase line, and whether BlueCare wants its own ABA authorization when a commercial plan is primary.
Coverage decides whether BlueCare Tennessee (BCBST) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the TennCare rule: direct ABA must be delivered by or supervised by a TN Licensed Behavior Analyst (or a health professional permissible under TN law), unlicensed persons work “under the extended authority and direction of a TN LBA,” and RBTs plus their supervising BCBAs must comply with all current BACB supervision requirements — which sets the operative floor at 5% of monthly service hours with two face-to-face contacts. BlueCare publishes no ratio of its own; its forms capture the provider’s name, credentials and NPI/Tax ID rather than a supervision schedule.[8][4]
Yes, when a protocol is actually modified. BlueCare’s July 2026 manual: "Providers should bill in a manner consistent with the CPT code descriptions. In addition, if the BCBA is directing an RBT, the client is present, and one or more protocols have been modified then 97155 may be billed concurrently with the RBT codes." Without a protocol change the default rule applies: "When the Board Certified/Licensed BCBA is physically present with the Member (with or without the Registered Behavior Technician (RBT) being present) then the procedure code for the claim would be the applicable service the BCBA provides." The shared program description still bars two different overlaps — more than one licensed analyst serving a member “during a specific time interval” and ABA delivered simultaneously with OT, speech, PT or psychotherapy — and the BCBST initiation form notes that “the hours per week authorized aren’t inclusive of other services being provided.”[1][8][4]
No per-day ceiling and no annual limit. BlueCare authorizes in 26-week (six-month) certification periods and its initiation/continuation form asks for hours per week by code, a clinical justification for any increase, and — “if concurrent” — the hours approved versus hours used in the last authorization period. That last field is the operative constraint: like every TennCare MCO, BlueCare expects an explanation when utilization of authorized direct-care units falls below 90%.[4][5]
BlueCare’s July 2026 manual sets the rule at the record level for every behavioral health provider. Treatment records need "Progress notes for each service contact documenting the date and time of service, duration/end time of service, the type of service provided, a summary of treatment interventions used, the treatment plan goals and objectives addressed in the session, and the name and credentials of rendering service Provider," and the manual’s record-keeping standards require that "Each recorded chart entry must be dated and identified by the author. Stamped signatures aren’t acceptable." Treatment plans are due within 30 days of the start of service and updated every six months, and each plan and review must be "signed by a Member, family member, or legally appointed representative." The ABA request forms add a request-level attestation that all pertinent clinical information was supplied. No signing deadline for session notes is published.[1][4][9]
Follows the TennCare rule: Clinic, Home, Community, School, Telehealth and Other are all on the universal form’s place-of-service grid, and medically necessary school-based behavioral health services “are not required to be included in a child’s Individualized educational plan (IEP) in order to be reimbursable.” BlueCare’s assessment form asks providers to state where “ABA therapy will be provided between the qualified practitioner and the individual member and/or caregiver at the following proposed location(s),” so the setting is authorized rather than assumed. IEP services and functioning as an educational aide remain non-covered.[8][5][9]
Follows the TennCare rule — the claim rides on the group or servicing provider with the practitioner level carried as a modifier (HO for analyst-delivered codes, HM for technician-delivered, 97153 split between them). BlueCare’s own forms collect “Provider ID, NPI Number, or Tax ID” plus the provider name and credentials; no separate rendering-versus-supervising NPI convention is published, and rates are contract-negotiated because TennCare publishes no ABA fee schedule.[5][4]
TennCare requires each plan to run at least one provider payment cycle a week, on the same day each week, as the plan sets and TennCare approves. The contract and the plan's manual do not publish the day or a submission cutoff time, so ask provider services which day the check run closes. Clean claims must be paid within 30 days (90% of them) and almost all claims processed within 60 days.
Yes. The universal ABA request form asks for cumulative graphs or charts of baseline data and current progress, with the current behavior support and treatment plans and the goals met during the authorization period. Functioning should be re-measured with standardized tools at least every two years.
No H-codes are published for ABA. The universal ABA request form is built on CPT 97151–97158, and the shared program description lists no HCPCS codes.
Yes — BlueCare administers the TennCare ABA benefit under the shared tri-MCO program description: EPSDT members under 21, prior authorization on assessment and treatment, TN LBA licensure for direct ABA.
Through Availity (or provider.bcbst.com), or by fax to (800) 292-5311 for BlueCare/TennCareSelect — using the universal tri-MCO ABA request form, plus BlueCare's initiation/continuation form for treatment. Standard decisions come within 7 calendar days of receipt (72 hours if expedited).
Clinically, no — the rules are the shared TennCare baseline. The differences are mechanical: BlueCare's portal, fax lines, supplemental form, and UM timelines.
Yes. BlueCare's Telehealth Approved Code List (updated March 10, 2026) lists every ABA code — 97151-97158, 0362T and 0373T — as payable with POS 02 or POS 10. Telehealth hours must still be requested per code on the universal ABA request form. For a commercial BCBST plan, see the BlueCross BlueShield of Tennessee guide.
There is no public ABA fee schedule. TennCare publishes none, and BlueCare pays according to the fee schedule in your BlueCare provider agreement; its telehealth guide says telehealth payment for many services is consistent with that same fee schedule. Your contract, or BlueCare network management, is the source for rates.
Yes, in practice. The shared TennCare program description sets credential expectations for "RBT paraprofessionals" who must keep the RBT credential under BACB rules, and BlueCare's manual says "the RBT service codes can be utilized by Registered Behavior Technicians, Board Certified Assistant Behavior Analysts (BCaBA) or by a Provider who has completed their training in Applied Behavior Analysis and is waiting to take the exam to become a Board Certified Behavior Analyst (BCBA)." TennCare does not pay immediate family members to deliver ABA.
There is no published open or closed status. BlueCare Tennessee's manual says it may "maintain a separate network and not include any willing Provider," and that it can deny participation for network need. Apply through BCBST credentialing and attest to the TennCare ABA program description, then ask provider network operations about need in your area.
120 days from the date of service, or 60 days from the original rejection notice if later; corrected bills within 120 days of the original remittance (BlueCare Tennessee provider manual, October 2026).
Yes. Professional claims need taxonomy codes for both the billing and rendering NPIs, matching what BlueCare has on file (BlueCare Tennessee provider manual).
Not in any published source. The shared TennCare MCO ABA Program Description and Tennessee’s licensing rules (1180-05) name no CPR or first-aid training for ABA staff; the TennCare MCO contract requires it only for consumer-directed CHOICES and ECF CHOICES workers. Your employer may still require it.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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