TN BlueCare Primary Care Provider Change Request Form 2013 free printable template

Bluesier TennCareSelect SM Primary Care Provider Change Request Form Member Information: Please complete and fax to: 18882619025 Member ID Date of birth (month/day/year) Member Name: First MI Last

How to fill out TN BlueCare Primary Care Provider Change

How to fill out TN BlueCare Primary Care Provider Change Request

1. Obtain the TN BlueCare Primary Care Provider Change Request form from the official BlueCare website or your local office.
2. Fill out your personal information at the top of the form, including your name, date of birth, and member ID.
3. Indicate your current primary care provider's information, including their name and contact details.
4. Provide the details of the new primary care provider you wish to change to, including their name, address, and phone number.
5. Sign and date the form to authorize the change request.
6. Submit the completed form to the appropriate BlueCare address or fax number provided in the instructions.

Who needs TN BlueCare Primary Care Provider Change Request?

1. Members of TN BlueCare who wish to change their primary care provider.
2. Individuals who are not satisfied with their current primary care services.
3. New members who need to designate a primary care provider for the first time.

People Also Ask about

What is the provider line for BCBS of Tennessee?

If you have questions about working with us, please find helpful resources on this website or call our Provider Service Line at 1-800-924-7141.

What is BlueCard PPO outside of Tennessee?

BlueCard® The BlueCard Program allows you to submit claims for members of BlueCross BlueShield Plans outside of Tennessee to us for processing and reimbursement. It links network providers and Blue Cross Blue Shield Plans across the country and around the world.

Is Blue Cross Blue Shield of Tennessee a PPO or HMO?

Like many insurance companies, BlueCross BlueShield of Tennessee's product offerings include the following types of plans: PPO.

Is BlueCare and TennCare the same?

We have two TennCare plans – BlueCare and TennCareSelect. Members with specific needs may also qualify for one of our four programs – SelectKids, SelectCommunity, CHOICES, and Employment and Community First CHOICES.

Does BCBS of TN require prior authorization?

Prior Authorization Information Prior authorization is required for certain procedures, services and medications, as well as for all inpatient admissions.

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What is TN BlueCare Primary Care Provider Change Request?

The TN BlueCare Primary Care Provider Change Request is a form that allows members of the BlueCare program in Tennessee to request a change in their assigned primary care provider (PCP).

Who is required to file TN BlueCare Primary Care Provider Change Request?

Members of the BlueCare program who wish to change their primary care provider are required to file the TN BlueCare Primary Care Provider Change Request.

How to fill out TN BlueCare Primary Care Provider Change Request?

To fill out the TN BlueCare Primary Care Provider Change Request, members need to provide their personal information, including member ID, current PCP details, and the new PCP they wish to select, followed by signing and submitting the form.

What is the purpose of TN BlueCare Primary Care Provider Change Request?

The purpose of the TN BlueCare Primary Care Provider Change Request is to facilitate the preferences of members regarding their healthcare by allowing them to change their assigned primary care provider as needed.

What information must be reported on TN BlueCare Primary Care Provider Change Request?

The information that must be reported includes the member's identification details, current primary care provider's name, the desired new primary care provider's name, and any relevant contact information.