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 medications for opioid use disorder (MOUD) 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

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 Medications for Opioid Use Disorder (MOUD)
  • 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

BESMART 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

For contracting questions:

Wellpoint: WLPBESMART@wellpoint.com
BlueCare: MAT_Referral_CM_UM@bcbst.com
UnitedHealthcare: SE_Government_Programs@uhc.com

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

Tips for searching for a community mental health center:

  • Click the Provider Portal link above.
  • Select Find Care.
  • Scroll down and Select Basic search as a guest.
  • Follow the prompts.
  • Enter location and search information in text box Community Mental Health Center.

Tips for searching for an outpatient substance use disorder provider:

  • Repeat the first four steps above.
  • Enter location and search information in text box There are options to search by specialty such as, Behavioral/substance use providers. You can also search by care provider using the radio buttons provided.

Provider Directory

Tips for searching for a community mental health center:

  • Click the Provider Directory 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.
  • To search for Child/Adolescent it is listed as Outpatient Substance Use Disorder (Adolescent).
  • To search for Adult it is listed as Substance Use Disorder (SUD) Counseling Adult.

Provider Directory

Tips for searching for a community mental health center:

  • Click the Provider Directory link above.
  • Select Medical Care Directory.
  • Select Medicaid Plans.
  • Select Tennessee.
  • Select United Healthcare Community Plan TennCare.
  • Change location adding specific region or address.
  • In the Search Bar, type in Community Mental Health Center.

Tips for searching for an Outpatient Substance Use Disorder provider:

  • Click the Find a Provider link above.
  • Select Live and Work Well.
  • Scroll down to Explore and select Find a provider.
  • Select Plan Type > Medicaid.
  • Enter city/location.
  • In the Search Bar, type Substance Use Disorders.
  • Select appropriate category from the drop-down list.
  • To drill down further to specific programs and services: under Filter Options, select the "Substance Use Disorders" button and check the box for specific program or service.
  • For more specific provider details (general overview, ages, locations, hours, services, and websites/hyperlinks) click on the selected provider, then select "locations" and "programs".

Are you concerned that your patients need:

  • Medications for Opioid Use Disorder (MOUD)
  • 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

MOUD Provider Referral Information

Portal for MOUD Providers

Tips for searching for a Medications for Opioid Use Disorder (MOUD) Provider:

  • Click the Provider Portal link above.
  • Select Patient Care.
  • Click Behavioral Health and scroll down to Related Information – choose MAT Providers for in-network BESMART provider list.

Provider Referrals:

For referrals to the Behavioral Health Case Management Team contact Provider Services:833-731-2154

Follow Prompts and select Case Management.

Behavioral Health Case Management referrals can also be sent to: WLPBehavioralHealthRef@wellpoint.com

Portal for MOUD Providers

Tips for searching for a Medications for Opioid Use Disorder (MOUD) Provider:

  • Click the BlueCross Provider link above.
  • 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.

MOUD Provider Referral Line:

800-814-8936

Portal for MOUD Providers

Tips for searching for a Medications for Opioid Use Disorder (MOUD) provider:

  • Click the link above.
  • Select Find a Provider.
  • Select Behavioral Health Directory.
  • Select Medicaid Plans.
  • Select Tennessee.
  • Select United Healthcare Community Plan TennCare.
  • Change location.
  • In search bar type: Medications for Opioid Use Disorder (MOUD).
  • Select specific provider to obtain additional details for locations, area of expertise, hours, ages.

Provider Services:

800-690-1606

  • Press 8 if this is related to behavioral health or substance use.
  • Say "Yes" if you are a provider, state your 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

For complex case referrals, contact Provider Services: 833-731-2149

Email referrals to case management: WLPBehavioralHealthRef@wellpoint.com

Referral Line:

888-416-3025

Provider Services:

800-690-1606

Email referrals to case management: tn_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:

833-731-2153

Wellpoint 24-Hour Nurse HelpLine: 866-864-2544

https://www.wellpoint.com/tn/medicaid

BlueCare Member Services:

800-468-9698

Member Services:

800-690-1606