Managed Care Information

Most CoverKids services are offered through managed care organizations (sometimes called “MCOs,” or “health plans.”). MCOs are responsible for helping to manage and coordinate the care that members receive. Each participating MCO creates its own contracts with providers, maintains their own fee schedules, processes their own claims, and has their own in-network specialists and providers.

The three MCOs that are available to CoverKids members are listed below. More information about each MCO (including member handbook information and provider directories) is available from each MCO.

MCO Contracts

• Amerigroup Community Care is owned by AMERIGROUP Corporation.
• BlueCare is owned and operated by Volunteer State Health Plan, Inc. (VSHP), which is an independent licensee of the BlueCross BlueShield Association and a licensed affiliate of its parent company, BlueCross Blue Shield of Tennessee.
• UnitedHealthCare Community Plan is owned and operated by UnitedHealthcare Plan of the River Valley, Inc..

See TennCare’s contracts with the MCOs.

MCO Accreditation

CoverKids MCOs are accredited by National Committee for Quality Assurance (NCQA). See more information about each MCO’s NCQA accreditation status.

Managed Care Quality Improvement Strategy

See the joint TennCare/CoverKids managed care quality improvement strategy.

Network Adequacy

On an ongoing basis, TennCare monitors the healthcare providers in each MCO’s network. The purpose of this monitoring is to ensure that each MCO has enough providers in its network to ensure timely access to care for all members. The current results of this network monitoring are illustrated below:

More information about CoverKids network adequacy standards is contained in the MCO contracts.