[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.

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.
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