TennCare Select is not a fourth TennCare MCO alongside BlueCare, UnitedHealthcare Community Plan, and Wellpoint — it's a separate state contract. TennCare Select operates as a Prepaid Inpatient Health Plan (PIHP) under its own agreement between the Division of TennCare and Volunteer State Health Plan, Inc. (d/b/a BlueCare Tennessee) — a distinct Edison contract ID from BlueCare's own MCO contract, even though both are run by the same BlueCross BlueShield of Tennessee subsidiary. Members don't choose TennCare Select; TennCare assigns them to it because they fall into specific categories — children receiving SSI, children in DCS (foster care) custody, enrollees in intellectual-disability HCBS waivers, and a handful of statewide safety-net groups. For ABA, the clinical rules are the same shared tri-MCO program covered in our main TennCare guide — what's different here is the population TennCare Select serves and the phone/fax/contact structure built around it.
The state's own contract text describes it plainly: "The Contractor shall operate under and market the services delivered via the prepaid Inpatient Health Plan (PIHP) as 'TennCare Select.'" That PIHP agreement (Edison Contract ID 83332, term 1/1/2025–12/31/2027) is separate from BlueCare Tennessee's standard MCO contract, though both sit with Volunteer State Health Plan. BlueCare Tennessee's own Provider Administration Manual confirms the setup: "TennCareSelect is the State's self-insured TennCare Health Maintenance Organization... administered by BlueCare Tennessee... Enrollees cannot choose TennCareSelect as their TennCare MCO; TennCare members assigned to the TennCareSelect MCO must meet certain criteria and must be assigned to the TennCareSelect MCO by the Division of TennCare." For ABA specifically, the same PAM section covers both BlueCare and TennCareSelect members under one shared policy — the same CPT codes (97151–97155, 0362T, 0373T), the same RBT/BCaBA/BCBA billing structure, and the same tri-MCO baseline (26-week authorization periods, severity-level justification, no fixed annual hour cap) that governs the rest of TennCare. Practically: if a family is on TennCare Select, plan clinically exactly as you would for BlueCare — the differences that matter are contact numbers and, for a subset of members, LTSS-specific programs. This structure is independently confirmed in the generic TennCare MCO Statewide Contract template (now current through Amendment 25, effective July 1, 2026, per its own cover page), which defines TennCare Select as a statewide backup MCO whose risk the State of Tennessee backs — created for MCO failure/inadequate-capacity scenarios and as the assigned plan for children in state custody and SSI-eligible children (who may opt out).[1][9][2]
TennCare assigns — rather than lets members pick — enrollees who fall into defined categories: children under 21 who are SSI-eligible; children in DCS (foster care) custody and those transitioning out of custody (branded "SelectKids"); enrollees receiving services in an institution or an HCBS 1915(c) waiver for intellectual disabilities; enrollees living out-of-state; enrollees TennCare couldn't contact; and members of the "Integrated Health Services Delivery Model" target population for intellectual disabilities, branded "SelectCommunity" — largely 1915(c) waiver enrollees and former ICF/IID ("Arlington class") residents. TennCare Select is also the sole administrator of the Katie Beckett Program Part A (non-Medicaid-eligible-by-income children with significant disabilities up to 18). For an ABA intake team, the practical read is: TennCare Select skews toward higher-acuity, higher-support-need members — foster youth, IDD/CHOICES populations, and SSI kids — more than a random cross-section of TennCare.[2]
TennCare's own Managed Care Program Annual Report (MCPAR), submitted to CMS on 6/29/2025 for reporting period CY2024, lists average monthly enrollment across TennCare's four managed-care products: Wellpoint Tennessee 438,735; BlueCare Tennessee 552,517; UnitedHealthcare Community Plan 439,049; and TennCare Select 37,095 — about 2.5% of statewide TennCare enrollment. That's the most current figure independently confirmed against a primary source; TennCare also publishes monthly enrollment spreadsheets that may carry a more current number, but those weren't retrievable during this review — treat 37,095 as the latest verified figure, not necessarily the latest available one.[3]
ABA requests use the shared tri-MCO universal request form, submitted through Availity for in-state providers or Cohere for out-of-state providers; PA questions route to (423) 535-5717, option 2. Two BCBST-hosted ABA forms — an "ABA Therapy Services Assessment Request Form" and an "Initiation and Continuation of ABA Therapy Form" (the latter confirming the 26-week/6-month certification period and a severity-level 1–3 field) — surfaced in this review, consistent with the tri-MCO baseline, but neither form's text explicitly labels itself TennCare Select-specific versus a general BCBST form; confirm the exact required form with BlueCare/TennCare Select provider relations before submitting. What is confirmed distinct is the contact structure: TennCare Select runs its own Member Service Line (1-800-263-5479, vs. BlueCare's 1-800-468-9698), Provider Service Line (1-800-276-1978, vs. 1-800-468-9736), and Prior Auth phone (1-800-711-4104, vs. BlueCare's 1-888-423-0131) — though the PA fax (1-800-292-5311) is shared with BlueCare. SelectKids (the foster-care population) carries its own further layer: Provider/Family Services at 1-800-451-9147 (fax 1-800-330-2842) and Member Services at 1-888-422-2963. SelectCommunity (the IDD population) has its own line, 1-800-292-8196 (fax 1-888-255-9175).[2][6][7]
TennCare Select is the exclusive administrator of SelectCommunity and Katie Beckett Part A, and shares CHOICES/ECF CHOICES LTSS administration with BlueCare — the MLTSS Provider Manual states plainly that "all BlueCare/TennCare Select billing guidelines apply" for these populations. That matters for staffing: TennCare's Aligned Background Check Protocol (effective July 1, 2024) governs providers serving 1915(c) waiver, Katie Beckett, Employment and Community First CHOICES, and CHOICES members — criminal background checks plus registry screening (TN Abuse Registry, National/TN Sex Offender Registry, LEIE, SAM, TennCare Terminated Provider List) within 30 days before first contact, monthly SAM/LEIE/TTPL rechecks. The protocol document itself refers generically to "Managed Care Organizations" rather than naming TennCare Select, but because TennCare Select administers exactly these programs, any ABA agency serving a TennCare Select family through SelectCommunity, ECF CHOICES, or Katie Beckett falls under it — the same guidance our main TennCare guide gives: if you serve Katie Beckett or CHOICES children, run the full protocol for everyone rather than trying to split by plan.[4][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.[2][11]
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.[2][11]
BlueCare’s provider manual covers TennCareSelect and sets its claim rules: claims must be received “within 120 days of the date of service,” or within 60 days of the original rejection notice if later; corrected bills within 120 days of the original remittance; when TennCareSelect 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”; professional claims need billing and rendering taxonomy codes that match the codes on file. Providers may ask the Commissioner of Commerce and Insurance for independent review of a disputed TennCare claim under Tenn. Code Ann. 56-32-126. Payment clock: the TennCareSelect contract requires that “ninety percent (90%) of clean claims for payment for services delivered to a TennCare enrollee are paid within thirty (30) calendar days of the receipt of such claims” (2.22.4.2) and 99.5% of all claims processed within 60 calendar days (2.22.4.3), and it requires at least “one (1) provider payment cycle per week, on the same day each week, as determined by the Contractor and approved in writing by TennCare”; neither the contract nor the manual names the day or a submission cutoff, so ask BlueCare which day the check run closes.[1][2]
Graphs are required. The universal ABA request form that TennCareSelect (administered by 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.[8][11]
The questions that decide whether a family can start with TennCare Select, 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 sets no age of its own. TennCare Select’s population skews younger and higher-acuity — SSI children under 21, DCS custody youth, Katie Beckett Part A children up to 18 — but the ABA age boundary is the state’s.[10][11][2]
Follows the TennCare rule: no recency limit on the ASD diagnosis, with updated evaluation of functioning by standardized tools expected at least every two years, and 26-week (six-month) certification periods. The BCBST forms that serve TennCare Select members ask for “Initial/First Date ASD Diagnosed” and the DSM severity level (1–3) without capping the report’s age; continuation requests “must be submitted at least once every six months.”[11][7]
Follows the TennCare rule — the diagnosis must come from “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. No TennCare Select-specific diagnostician rule exists; the BCBST forms ask only for diagnostic confirmation and severity level.[11][6]
Follows the TennCare rule: no named instrument, but 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. BCBST’s forms capture severity level and measurable goals rather than a required test battery.[11][7]
Follows the TennCare rule — the assessment request needs the diagnostic report plus a doctor’s order; the BCBST forms ask for “diagnostic confirmation like diagnostic reports, doctor’s orders, etc.” TennCare Select-specific mechanics: Tennessee providers submit in Availity, out-of-state providers through Cohere, and PA questions route to (423) 535-5717, option 2, with TennCare Select’s own prior-auth line at 1-800-711-4104 (fax 1-800-292-5311 is shared with BlueCare).[6][7][11]
TennCareSelect runs on BlueCare’s rules here. 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.[13][2][14][8][11]
TennCareSelect is administered by BlueCare Tennessee, and the shared July 2026 BlueCare Tennessee manual governs it: 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.[2][9][7]
Other coverage is routine on TennCareSelect. Children in Katie Beckett Part A "must have a primary payer or third-party liability (TPL) that will be their first payor with Medicaid paying secondary," and TennCareSelect is their plan. 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."[2][9][15][16]
Ask the plan: BlueCare Tennessee Provider Service / UM (Availity) — ask whether an ABA claim falls under the "TennCare Kids" pay-and-chase line, and whether TennCareSelect wants its own ABA authorization when a commercial plan is primary.
Coverage decides whether TennCare Select 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 or supervised by a TN Licensed Behavior Analyst (or a health professional permissible under TN law), unlicensed persons work under the LBA’s extended authority and direction, and RBTs with their supervising BCBAs must meet all current BACB supervision requirements — the operative floor being 5% of monthly service hours with two face-to-face contacts. One TennCare Select-specific staffing overlay matters more than the ratio: members in CHOICES, ECF CHOICES, 1915(c) waivers or Katie Beckett trigger TennCare’s Aligned Background Check Protocol for every employee with direct member contact.[11][2]
Yes, when a protocol is actually modified. The BlueCare Tennessee manual, which also governs TennCareSelect (July 2026): "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.”[2][11][7]
No per-day ceiling and no annual benefit limit. Authorizations run 26 weeks and the BCBST initiation/continuation form asks for hours per week by code plus a clinical justification for any increase and, “if concurrent,” hours approved versus hours used in the last authorization period — the same sub-90% utilization discipline the whole program applies to 97153. Group sizes are capped as best practice at six to eight participants.[7][11]
The BlueCare Tennessee manual, which also governs TennCareSelect (July 2026), 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." No signing deadline for session notes is published.[2][7][6]
Follows the TennCare rule — Clinic, Home, Community, School, Telehealth and Other are all requestable, and medically necessary school-based behavioral health services need not be in an IEP to be reimbursable; IEP services and functioning as an educational aide stay non-covered. BCBST’s assessment form asks providers to state the “proposed location(s)” where ABA will be delivered, so setting is authorized rather than assumed.[11][8][6]
Follows the TennCare rule — the claim rides on the group or servicing provider, with practitioner level carried as a modifier (HO analyst-delivered, HM technician-delivered, 97153 split). BlueCare’s Provider Administration Manual covers BlueCare and TennCareSelect members under one shared ABA policy with the same codes (97151–97155, 0362T, 0373T) and the same RBT/BCaBA/BCBA billing structure, and the BCBST forms collect “Provider ID, NPI Number, or Tax ID.” Rates are contract-negotiated.[2][8][7]
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.
No — they're separate state contracts (different Edison contract IDs) even though both are administered by Volunteer State Health Plan, a BlueCross BlueShield of Tennessee subsidiary. Members are assigned to TennCare Select by the Division of TennCare, not chosen; contact numbers and some LTSS programs differ.
SSI-eligible children under 21, children in DCS foster-care custody ("SelectKids"), members in intellectual-disability HCBS waivers ("SelectCommunity"), Katie Beckett Part A children, and some out-of-state or safety-net enrollees — roughly 37,095 members statewide (CY2024 average).
Yes — the same shared tri-MCO ABA program that governs BlueCare, UnitedHealthcare Community Plan, and Wellpoint: EPSDT members under 21, prior authorization on assessment and treatment, TN Licensed Behavior Analyst licensure, 26-week authorization periods.
The shared tri-MCO universal ABA request form, via Availity (Tennessee providers) or Cohere (out-of-state providers). TennCare Select's own Provider Service Line is 1-800-276-1978 and PA phone is 1-800-711-4104 — both distinct from BlueCare's numbers.
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 (BlueCare Tennessee provider manual, which covers TennCareSelect).
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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