Part 3 Parentage and Legitimation 36-2-301 – 36-2-322
Part 4 Parentage of Children Born of Donated Embryo Transfer 36-2-401 – 36-2-403

Terms Used In Tennessee Code > Title 36 > Chapter 2

  • Adverse determination: means :

    • (A) A determination by a health carrier or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health carrier's health benefit plan does not meet the health carrier's requirements for medical necessity, appropriateness, healthcare setting, level of care or effectiveness and the requested benefit is therefore denied, reduced or terminated or payment is not provided or made, in whole or in part, for the benefit. See Tennessee Code 56-61-102

    • Affiliate: means an individual or entity that directly or indirectly through one (1) or more intermediaries, controls or is controlled by or is under common control with a contracting entity. See Tennessee Code 56-60-102
    • Age of majority: means eighteen (18) years of age or older. See Tennessee Code 1-3-105
    • Aggrieved person: means :

      • (A) A healthcare provider. See Tennessee Code 56-61-102

      • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
      • Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
      • Attorney: means the person designated and authorized by subscribers as the attorney-in-fact having authority to obligate them on reciprocal insurance contracts. See Tennessee Code 56-16-102
      • Authorized representative: means :

        • (A) A person to whom a covered person has given express written consent to represent the covered person for purposes of this chapter. See Tennessee Code 56-61-102

        • benefits: means those healthcare services to which a covered person is entitled under the terms of a health benefit plan. See Tennessee Code 56-61-102
        • Child born out of wedlock: means a child born to parents who are not married to each other when the child was born. See Tennessee Code 36-2-302
        • Clinical peer: means a physician or other healthcare professional who holds a nonrestricted license in a state of the United States and in the same or similar specialty that would typically manage the medical condition, procedure or treatment under review. See Tennessee Code 56-61-102
        • Clinical review criteria: means the written screening procedures, decision abstracts, clinical protocols and practice guidelines used by the health carrier to determine the medical necessity and appropriateness of healthcare services. See Tennessee Code 56-61-102
        • Closed plan: means a managed care plan that requires covered persons to use participating providers under the terms of the managed care plan or the plan will not provide covered benefits to the covered person. See Tennessee Code 56-61-102
        • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-61-102
        • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
        • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
        • Contracting entity: means any individual or entity that is engaged in the act of contracting with providers and that has entered into a provider network contract with a provider for the delivery of health care services. See Tennessee Code 56-60-102
        • Court: means the juvenile court or any trial court with general jurisdiction. See Tennessee Code 36-2-302
        • Covered person: means a policyholder, subscriber, enrollee or other individual participating in a health benefit plan. See Tennessee Code 56-61-102
        • Date of foreclosure: means the date on which the holder obtains legal or equitable title or possession to the site, vessel or facility pursuant to or incident to foreclosure. See Tennessee Code 68-212-401
        • Department: means the department of commerce and insurance. See Tennessee Code 56-60-102
        • Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
        • Department: means the department of environment and conservation. See Tennessee Code 68-212-401
        • Discount medical plan organization: means an entity that, in exchange for fees, dues, charges or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount. See Tennessee Code 56-60-102
        • Dismissal: The dropping of a case by the judge without further consideration or hearing. Source:
        • Donor: The person who makes a gift.
        • Embryo parentage: means the acceptance of rights and responsibilities for an embryo by a recipient intended parent. See Tennessee Code 36-2-402
        • Embryo transfer: means the medical procedure of physically placing an embryo into the uterus of a female recipient intended parent. See Tennessee Code 36-2-402
        • Emergency medical condition: means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical attention, where failure to provide medical attention would result in serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy. See Tennessee Code 56-61-102
        • Emergency services: means healthcare items and services furnished or required to evaluate and treat an emergency medical condition. See Tennessee Code 56-61-102
        • Entity: means a corporation, business trust, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency or instrumentality, or any other legal or commercial entity. See Tennessee Code 56-60-102
        • Facility: means an institution licensed under title 68 providing healthcare services or a healthcare setting, including but not limited to, hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation. See Tennessee Code 56-61-102
        • Facility: means :

          • (A) Any building, structure, installation, equipment, pipe or pipeline (including any pipe into a sewer or publicly owned treatment works), well, pit, pond, lagoon, impoundment, ditch, landfill, storage container, motor vehicle, rolling stock, or aircraft. See Tennessee Code 68-212-401

          • Fair consideration: means the value of the security interest when calculated as an amount equal to or in excess of the sum of the outstanding principal (or comparable amount in the case of a lease that constitutes a security interest) owed to the holder immediately preceding the acquisition of full title (or possession in the case of property subject to a lease financing transaction) pursuant to foreclosure and its equivalents, plus any unpaid interest, rent or penalties (whether arising before or after foreclosure and its equivalents), plus all reasonable and necessary costs, fees, or other charges incurred by the holder incident to work out, foreclosure and its equivalents, retention, maintaining the business activities of the enterprise, preserving, protecting and preparing the site, vessel or facility prior to sale, re-lease of property held pursuant to a lease financing transaction (whether by a new lease financing transaction or substitution of the lessee) or other disposition, plus response costs incurred under applicable federal, state or local environmental cleanup laws or regulations, or at the direction of an on-scene coordinator, less any amounts received by the holder in connection with a partial disposition of the property, net revenues received as a result of maintaining the business activities of the enterprise, and any amounts paid by the borrower subsequent to the acquisition of full title (or possession in the case of properties subject to lease financing transactions) pursuant to foreclosure and its equivalents. See Tennessee Code 68-212-401
          • Father: means the biological father of a child born out of wedlock. See Tennessee Code 36-2-302
          • Final adverse determination: means an adverse determination involving a covered benefit that has been upheld by a health carrier at the completion of the health carrier's internal grievance process procedures as set forth in this chapter. See Tennessee Code 56-61-102
          • Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
          • foreclosure and its equivalents: means purchase at foreclosure sale, acquisition or assignment of title in lieu of foreclosure, termination of a lease or other repossession, acquisition of a right to title or possession, an agreement in satisfaction of the obligation, or any other formal or informal manner (whether pursuant to law or under warranties, covenants, conditions, representations or promises from the borrower) by which the holder acquires title to or possession of the secured property. See Tennessee Code 68-212-401
          • Grievance: means a written appeal of an adverse determination or final adverse determination submitted by or on behalf of a covered person regarding:

            • (A) Availability, delivery or quality of healthcare services regarding an adverse determination. See Tennessee Code 56-61-102

            • Health benefit plan: means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services. See Tennessee Code 56-61-102
            • Health care services: means services for the diagnosis, prevention, treatment or cure of a health condition, illness, injury or disease. See Tennessee Code 56-60-102
            • Health carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or healthcare services. See Tennessee Code 56-61-102
            • Health insurance plan: means any hospital and medical expense incurred policy, nonprofit health care service plan contract, health maintenance organization subscriber contract or any other health care plan or arrangement that pays for or furnishes medical or health care services, whether by insurance or otherwise. See Tennessee Code 56-60-102
            • Healthcare professional: means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law. See Tennessee Code 56-61-102
            • Healthcare services: means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease. See Tennessee Code 56-61-102
            • Holder: is a person who maintains indicia of ownership primarily to protect a security interest. See Tennessee Code 68-212-401
            • human embryo: means an individual fertilized ovum of the human species from the single-cell stage to eight-week development. See Tennessee Code 36-2-402
            • Indicia of ownership: means evidence of a security interest, evidence of an interest in a security interest, or evidence of an interest in real or personal property securing a loan or other obligation, including any legal or equitable title to real or personal property acquired incident to foreclosure and its equivalents. See Tennessee Code 68-212-401
            • insurance company: includes all corporations, associations, partnerships, or individuals engaged as principals in the business of insurance. See Tennessee Code 56-1-102
            • Legal embryo custodian: means the person or entity, including an embryo transfer clinic, who hold the legal rights and responsibilities for a human embryo and who relinquishes said embryo to another person. See Tennessee Code 36-2-402
            • legal transfer of rights to an embryo: means the relinquishment of rights and responsibilities by the person or persons who hold the legal rights and responsibilities for an embryo. See Tennessee Code 36-2-402
            • Lien: A claim against real or personal property in satisfaction of a debt.
            • Managed care plan: includes :

              • (A) A closed plan, as defined in subdivision (6). See Tennessee Code 56-61-102

              • medical necessity: means healthcare services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are:

                • (A) In accordance with generally accepted standards of medical practice. See Tennessee Code 56-61-102

                • Medical or scientific evidence: means evidence found in the following sources. See Tennessee Code 56-61-102
                • Mother: means the biological mother of a child born out of wedlock. See Tennessee Code 36-2-302
                • Open plan: means a managed care plan, other than a closed plan, that provides incentives, including financial incentives, for covered persons to use participating providers under the terms of the managed care plan. See Tennessee Code 56-61-102
                • Oversight: Committee review of the activities of a Federal agency or program.
                • Parent: means the biological mother or biological father of a child, regardless of the marital status of the mother and father. See Tennessee Code 36-2-302
                • participate in the management: means actual participation in the management or operational affairs by the holder of the security interest and does not include the mere capacity, or ability to influence, or the unexercised right to control a site, vessel or facility operations. See Tennessee Code 68-212-401
                • Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
                • Person: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the entities listed in this subdivision (28). See Tennessee Code 56-61-102
                • Personal representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
                • Physician: means any individual licensed as a chiropractic physician under title 63, chapter 4. See Tennessee Code 56-60-102
                • Physician hospital organization: means an organization that includes, but is not limited to, hospitals and physicians and that contracts with and provides administrative services to hospitals and physicians that have entered into or intend to enter into managed care arrangements. See Tennessee Code 56-60-102
                • Physician organization: means an organization that contracts with and provides administrative services to physicians who have entered into managed care arrangements. See Tennessee Code 56-60-102
                • Primarily to protect a security interest: means that the holder's indicia of ownership are held primarily for the purpose of securing payment or performance of an obligation, but does not include indicia of ownership held primarily for investment purposes, nor ownership indicia held primarily for purposes other than as a protection of a security interest. See Tennessee Code 68-212-401
                • Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
                • Prospective review: means utilization review conducted prior to an admission or the provision of a healthcare service or a course of treatment in accordance with a health carrier's requirement that the healthcare service or course of treatment, in whole or in part, be approved prior to its provision or admission. See Tennessee Code 56-61-102
                • Provider: means a physician, a physician organization or a physician hospital organization. See Tennessee Code 56-60-102
                • provider: means a healthcare professional or a facility. See Tennessee Code 56-61-102
                • Recipient intended parent: means a person or persons who receive a relinquished embryo and who accepts full legal rights and responsibilities for such embryo and any child that may be born as a result of embryo transfer. See Tennessee Code 36-2-402
                • Register: means the written records kept by a health carrier to document all grievances received during a calendar year. See Tennessee Code 56-61-102
                • Retrospective review: means any review of a request for a benefit that is not a prospective review request. See Tennessee Code 56-61-102
                • Security interest: means an interest in a site, vessel or facility created or established for the purpose of securing a loan or other obligation. See Tennessee Code 68-212-401
                • Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
                • Summons: Another word for subpoena used by the criminal justice system.
                • Third party: means an organization that enters into a contract with a contracting entity or with another third party to gain access to a provider network contract. See Tennessee Code 56-60-102
                • under common control with: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of an individual or entity, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the individual or entity. See Tennessee Code 56-60-102
                • Urgent care request: means a request for a healthcare service or course of treatment with respect to which the time periods for making nonurgent care request determination:

                  • (i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function. See Tennessee Code 56-61-102

                  • Vessel: means every description of watercraft or other artificial contrivance used, or capable of being used, as a means of transportation on water. See Tennessee Code 68-212-401