(a) As used in this section:

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Terms Used In Tennessee Code 68-11-245

  • Commissioner: means the commissioner of health, the commissioner's authorized representative, or in the event of the commissioner's absence or a vacancy in the office of commissioner, the deputy commissioner of health. See Tennessee Code 68-11-201
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Facility: means any institution, place or building providing health care services that is required to be licensed under this chapter. See Tennessee Code 68-11-201
  • Hospital: means any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with the services of a physician or dentist, of one (1) or more nonrelated persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment. See Tennessee Code 68-11-201
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
  • Patient: includes , but is not limited to, any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care. See Tennessee Code 68-11-201
  • 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
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
(1) “Communication” means written or electronic correspondence among a healthcare facility, health insurance entity, or provider concerning a prior authorization;
(2) “Health insurance coverage” has the same meaning as defined in § 56-7-109;
(3) “Health insurance entity” means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, and a nonprofit hospital and medical service corporation;
(4) “Healthcare facility”:

(A) Means an institution, place, or building providing healthcare services that is required to be licensed under this chapter; and
(B) Excludes emergency room and in-patient services provided at a hospital as defined in § 68-11-201;
(5) “Healthcare service” means a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease;
(6) “Minor” means an individual who has not attained eighteen (18) years of age;
(7) “Policyholder” means an individual who has contracted with a health insurance entity for healthcare services coverage; and
(8) “Provider” means an individual or entity performing services regulated pursuant to title 63 or this chapter, with whom the health insurance entity has an express and valid network provider agreement or contract.
(b) Except as provided in subsection (d), a healthcare facility shall notify a patient of communication between the healthcare facility and a health insurance entity or provider concerning additional information needed to process a prior authorization request for the patient within five (5) business days after the communication has occurred. The notification must include a brief summary of the communication or a copy of the communication.
(c) The healthcare facility shall notify the patient via electronic means, such as by email or through an online patient portal offered by the healthcare facility, unless the patient requests, in writing, an alternative notification method.
(d) If the patient is a minor, then the healthcare facility must notify the policyholder whose health insurance coverage covers the minor.
(e) This section does not apply to the TennCare program or a successor to the program provided for in the Medical Assistance Act of 1968, compiled in title 71, chapter 5, or to the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11 or a successor program.
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