Office-based Buprenorphine Treatment

Buprenorphine Enhanced Medication Assisted Recovery and Treatment (BESMART) Program

BESMART was developed in 2019 to be a specialized provider network focused on contracting with high quality medication assisted treatment (MAT) providers to provide comprehensive care to TennCare members with opioid use disorder (OUD).

  1. Must be a TennCare provider.
  2. Must have a specific contract with each Managed Care Organization (MCO) for BESMART.
  3. Must complete the BESMART attestation, attesting to the BESMART program description.

Not yet a TennCare provider? Visit Provider Registration to learn more.

BESMART Program Description

Note: The program description content is the same for all MCOs.

The following are benefits for providers in the BESMART program:

  • Clinical and care coordination support from MCOs
  • Increased data on quality and health outcomes
  • Enhanced reimbursement from the MCOs for defined BESMART services
  • Access to monoproduct buprenorphine
  • Shortened Prior Authorization Form

Buprenorphine Prior Authorization Form

Note: The Prior Authorization Form can be submitted via fax or electronically. It cannot be submitted over the phone.

Please contact OptumRx with questions or feedback.

OptumRx Call Center

Phone: 1-866-434-5524

  • Members can access increased buprenorphine treatment dosage options through BESMART providers

TennCare members who receive OUD treatment by a BESMART Provider will be eligible to receive buprenorphine product coverage with the following daily dosage limits:

  • Up to 16mg of buprenorphine products per day throughout induction, stabilization, and maintenance phases as medically necessary
  • If specific clinical criteria are met, may receive a maximum daily dosage of 24mg of buprenorphine products for the defined length of time established in in the clinical criteria

Deep Dive: 16 mg buprenorphine

BESMART Provider

  • Follow best practice guidelines about tapering down or off treatment
  • Follow best practice guidelines about utilizing lowest effective dose of Medication Assisted Treatment (MAT)
  • Attest to the requirements of the BESMART Program Description

TennCare Member

  • Members can receive up to 16 mg buprenorphine containing products daily

Deep Dive: 24 mg buprenorphine

BESMART Provider

  • Can prescribe maximum daily dosage of 24 mg of buprenorphine for specific populations
  • Cannot exceed one year in duration for 24 mg

Eligible TennCare Member Populations

  • Pregnant participants confirmed by provider attestation
  • Postpartum participants for a period of 12 months from delivery date as shown by medical records or insurance claim
  • Recent intravenous drug users confirmed by prescriber attestation and a positive urine drug screen
  • Current users receiving greater than 50mg of methadone for OUD treatment transitioning to buprenorphine agonist therapy
  • Current users of 16mg-24mg per day of buprenorphine demonstrated by paid claims data from the participants previous health insurer

The following describe the steps to become a BESMART provider:

  • Understand the program description and evaluate your current care model

BESMART Program Description

Note: The program description content is the same for all MCOs.

BlueCare BESMART program description

Amerigroup BESMART program description

UnitedHealthcare program description

  • Identify any potential gaps or areas for increased support from MCOs
  • Obtain a Medicaid Provider ID (if needed)
  • Indicate interest in joining BESMART and ability to meet program standard

BESMART Provider Interest Form

Complete the BESMART Provider Interest Form.

  • Contract as a BESMART provider with appropriate MCO(s) to join network
  • Continue to provide high-quality MAT care to TennCare members

As outlined in Public Chapter Nos. 761 and 771, Nurse Practitioners (NPs) and Physician Assistants (PAs) must participate in at least one MCO’s network of BESMART providers in order to be reimbursed for the prescription of buprenorphine.

To be eligible to contract with TennCare as a BESMART Provider, a NP or PA must also meet the following criteria:

  • Contracted in the BESMART Program
  • Has a supervising physician that is contract within the MCO’s BESMART Program
  • Specializes in family, adult, or psychiatric medicine
  • Part of an Office-based Opioid Treatment center (OBOT), Community Mental Health Center (CMHC), or Federally Qualified Health Center (FQHC)
  • Holds an X-DEA number and TennCare Medicaid ID
  • Follows member limits according to the legislation

NP & PA Prescribing Guidance Webinar (August 2020)

For contracting questions:

For prescribing questions:

Referral Information for Outpatient Mental Health & Substance Use Disorder Treatment and Services and Treatment for Complex Cases

TennCare Managed Care Organization (MCO) Provider Directory Links

Provider Directory/Provider Portal

Tips for searching for a community mental health center:

  • Click the Provider Portal link above.
  • Select Location and Plan.
  • Click Places by Type and enter Community Mental Health Center.

Tips for searching for an outpatient substance use disorder provider:

  • Repeat the first two steps above
  • Click Doctors by specialty and enter Outpatient Substance Abuse Treatment Services.

Provider Directory

Tips for searching for a community mental health center:

  • Click the Find a Doctor link above.
  • Change All Networks to BlueCare.
  • To narrow the search, enter your City, State and Zip Code.
  • Search for Behavioral Health Facility.

Tips for searching for an outpatient substance use disorder provider:

  • Repeat the four steps above.
  • Click the More Filters option and select Expertise.

Select the appropriate category from the drop-down list.

Provider Directory

Tips for searching for a community mental health center:

  • Click on liveandworkwell.com.
  • Enter city/location.
  • From left menu, select Coverage/Plan Type > Medicaid.
  • Search Community Mental Health Center.

Tips for searching for an outpatient substance use disorder provider:

  • Repeat the first three steps above.
  • Search Outpatient Substance Use Disorder.

Are you concerned that your patients need:

  • Medication-Assisted Treatment (MAT)
  • Assistance with behavioral health appointments/resources
  • Assistance with scheduling a follow-up appointment with a primary care provider
  • Additional information about their health care benefits
  • Advocacy and assistance in finding health care specialists
  • MCO-level case management because they are chronically ill

TennCare’s (Buprenorphine Enhanced Supportive Medication Assisted Recovery and Treatment ) BESMART Network Provider Referral Information

Portal for MAT providers

Tips for searching for a Medication Assisted Treatment Provider:

  • Click the Provider Portal link above.
  • Select Location and Plan.
  • Click Doctors by specialty and enter Medication Assisted Treatment.

For referrals to the Behavioral Health Case Management Team:

  • Contact Provider Services at 1-800-454-3730.
  • Follow prompts and select Case Management.

Portal for MAT providers

Tips for searching for a Medication Assisted Treatment Provider:

  • Choose BlueCare Network.
  • Enter your location.
  • Choose Medication-Assisted Treatment.
  • You may need to expand the distance to 50 miles for some remote areas.
  • Doctors have limited waivers and availability will fluctuate, so providing multiple options is possible.

MAT Provider Referral Line:

800-814-8936

Portal for MAT providers

Tips for searching for a MAT provider:

  • Click Search for a Provider.
  • Click Behavioral Health Directory.
  • Choose Plan and Location.
  • Enter Medication Assisted Treatment.

Provider Services:

  • Call 800-690-1606.
  • Say “yes” if you are a provider.
  • State reason for calling (e.g., find a provider for referral).
  • Enter the member’s identification number.

TennCare Managed Care Organization Contacts for Complex Cases

Note: Use this information if your patients have challenging medical and behavioral health conditions and you need additional assistance locating an inpatient or outpatient provider.

If you need help scheduling an outpatient appointment for a patient with complex medical or behavioral health needs, please contact the member’s TennCare MCO.

TennCare Provider Referral Information

Monday – Friday 8 a.m. – 5 p.m.

Susan Hinson RN CCM
Emergency Department/BH Team Lead
901-232-6716

susan.hinson@amerigroup.com

Outside of Business Hours:

Amerigroup ED Referral Voice Mailbox for Case Management
615-882-8212

Email referrals to case management: AGPBehavioralHealthRef@amerigroup.com

Referral Line:

888-416-3025

Email referrals to case managementcm_ref@BCBST.com

Provider Services:

800-690-1606

Email referrals to case managementtn_case_management@uhc.com

Inpatient Assistance:

If you need assistance with discharge planning, contact your assigned UHC Utilization Nurse and they can refer you to a Discharge Care Manager.

Member Contact Information

Member Services:

800-600-4441

Amerigroup On Call 24/7:

866-864-2544

https://www.myamerigroup.com/tn/home.html

BlueCare Member Services:

800-468-9698

Member Services:

800-690-1606