[Effective 1/1/2025]

(a) A health carrier or utilization review organization shall make all current prior authorization requirements readily accessible on its website to healthcare providers.
lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Tennessee Code 56-7-3719

  • Prior authorization: means a written or oral determination made by a health carrier or utilization review organization, or an agent of such carrier or organization, that an enrollee's receipt of a healthcare service is a covered benefit under the applicable plan and that a requirement of medical necessity or other requirements imposed by such utilization review organization as prerequisites for payment for such services have been satisfied. See Tennessee Code 56-7-3702
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Utilization review organization: means :
    (A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier. See Tennessee Code 56-7-3702
(b) The website must indicate each service subject to prior authorization while satisfying the following requirements:

(1) Putting the lettering and notification for each service in bold typeface;
(2) Indicating when prior authorization became required for policies issued or delivered in this state, including the termination date or dates, if applicable;
(3) Identifying the date when the Tennessee-specific requirement was listed on the health carrier’s or its contracted review utilization review organization’s website;
(4) Providing the date, the prior authorization requirement was removed from the Tennessee-issued policy, if applicable; and
(5) Providing access to a standardized electronic prior authorization request transaction process, if applicable.
  Previous section
Next section  
 Part 37 Contents