Blue cross blue shield of tennessee prior authorization form

Always check benefits through the Voice Response Unit (VRU) or My Insurance ManagerSM to determine if prior authorization is required.

Table of Contents Show

Prior authorization for medical services
Prior authorization for behavioral health services
A Message From Todd Ray (Please note updates are frequent)
For BlueCare, TennCareSelect and CoverKids lines of business unless stated otherwise.
COVID-19 Vaccine
COVID-19 Testing and Treatment
COVID-19 Drive-Through Testing
COVID-19 Antibody Tests
Telehealth Coverage
Contracting, Credentialing and Enrollment
Your Health
Protecting Yourself and Others
BlueCross Working for You
How do I contact Blue Cross Blue Shield of Tennessee?
Does BCBS TN require referral?
Where is BCBS of Tennessee located?

Many of our plans require prior authorization for certain procedures and durable medical equipment. This process allows us to check ahead of time whether services meet criteria for coverage by a member’s health plan.

In many cases, approval is instant. When it’s not, we’ll review your request, taking into account:

Our medical policies
Recognized clinical guidelines
Out-of-area patients (BlueCard®)
The terms of the member’s benefit plan

Some requests may require additional documentation.

Prior authorization for medical services

When you request prior authorization from us, we want the process to be fast, easy and accurate. We offer these convenient options:

Medical Forms Resource Center (MFRC) – This online tool makes it easy to submit prior authorization requests for certain services. The tool guides you through all of the forms you need so you can avoid follow-up calls for additional information.
My Insurance Manager – You also can submit prior authorization using the same online self-service provider tool you can use to check eligibility, manage claims and more.
Fax – If you would prefer to submit your request by fax, complete and follow the submission directions on this form:
- Precertification Request Form

Prior authorization for behavioral health services

A few plans may continue to require prior authorization for behavioral health services to include applied behavioral analysis (ABA) therapy. To request prior authorization, contact Companion Benefits Alternatives (CBA) using one of the below options:

Calling 800-868-1032
Forms Resource Center – This online tool makes it easy for behavioral health clinicians to submit behavioral health prior authorization requests. The tool guides you through all of the forms you need so you can avoid follow-up calls for additional information.

CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueCross.

Last Updated on September 8, 2022

Please refer to this section for helpful information about treating BlueCare Tennessee members during the COVID-19 state of emergency.

A Message From Todd Ray (Please note updates are frequent)

We’d like to point you toward helpful resources, where you can get daily updates about providing treatment during the COVID-19 emergency:

Read more about the State of Tennessee’s response to the disease on the Tennessee Department of Health website. Find updates from the Division of TennCare here.
Click here for the latest information from the Centers for Disease Control and Prevention (CDC).

For more general information about coronavirus resources available to the public, you may also call the Tennessee Coronavirus Public Information Line at 1-877-857-2945.

We’re Here To Support You

During surges in COVID-19, we've taken significant steps to remove barriers for members to receive care while streamlining certain necessary requirements for our providers. Steps we’ve taken to date include:

Beginning Aug. 13, 2021, until March 31, 2022, BlueCare Tennessee waived the prior authorization requirement for initial post-acute care reviews (skilled nursing facility, rehab and LTACH) to support rapid placement and discharge of currently hospitalized patients who can be safely discharged to another setting.
BlueCare Tennessee is allowing flexibility to charge inpatient rates in the emergency department or other units where patients may need to be housed, based on intensity of service.
We’ve permanently added flu testing and COVID-19 tests to BlueCare's exclusive lab exception list.
If a hospital requests to extend appeals timeframes past 180 days, we’ll approve reasonable requests on a case-by-case basis.
BlueCare suspended all medical record requests and audits for inpatient and outpatient facility claims, and postponed manual collection of medical records for HEDIS and in-office reviews for Quality and Value-based programs, through March 31, 2021. Moving forward, if hospitals request an extension of these due to staffing shortages, overwhelmed hospital capacity or other factors, we’ll review on a case-by-case basis and make accommodations as appropriate.
BlueCare is paying for COVID testing prior to inpatient admission separately, even if within the 72-hour window where it would normally be included in the DRG.
BlueCare is permanently waiving readmission penalties for COVID-19 hospital stays, unless there’s evidence of an unsafe discharge.

We’ll keep you updated on changes as they occur.

BlueCare Tennessee Telehealth and Telephonic/Audio-Only Services Update

COVID-19 Emergency Disclaimer

During the COVID-19 emergency, or until further notice, we’ll continue to follow the COVID-19-related policies and processes listed in this section of the BCBSTupdates website. Many of our decisions are guided by federal and state mandates, which occur frequently, so we encourage you to refer to this site daily. Should we decide to make a non-mandated change to a policy or process listed in the provider Q&As during the COVID-19 emergency, we’ll post the update 30 days in advance on this site.

For BlueCare, TennCareSelect and CoverKids lines of business unless stated otherwise.

COVID-19 Vaccine

COVID-19 Testing and Treatment

COVID-19 Drive-Through Testing

COVID-19 Antibody Tests

Telehealth Coverage

Contracting, Credentialing and Enrollment

Operations

Procedural

CPT® is a registered trademark of the American Medical Association

Your Health

Protecting Yourself and Others

BlueCross Working for You

How do I contact Blue Cross Blue Shield of Tennessee?

1-800-292-8196..

TRS users should call: 711 (Ask for 888-418-0008).

EMAIL US..

Does BCBS TN require referral?

Services that require an OK. Your benefits cover the most common types of care. Other health care services may require a referral from your PCP and an OK from us. An OK is called a prior authorization.