Prior authorization helps you get the most for your health care dollar. Registered nurses work with physicians to check and monitor medical services to help assure that you receive the most appropriate and cost-effective care for your condition. Only a physician can deny a prior authorization request.
Services that require Prior Authorization include, but are not limited to:
Network providers in Tennessee will request prior authorization for you.
If you use providers outside Tennessee or out-of-network providers, it is your responsibility to request prior authorization by calling the number on the back of your member ID card. Failure to request prior authorization may result in your benefits being reduced or denied, costing you more out-of-pocket.