Authorization & Appeals

Request prior authorization and submit appeals

Sometimes you’ll need to get approval before providing certain services to your patients. We’ve outlined requirements and the process for authorization below.

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Provider Administration Manual

Prior authorization information

Prior authorization is required for certain types of care. For detailed information, please see the Provider Administration Manual.

BlueCare Tennessee Provider Administration Manual

Prior Authorization Requests

You can submit prior authorization requests for all lines of business 24/7 at Availity.com.

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Authorizations & Appeals

Requesting approval for services

Review services that require special approval

Services Requiring Authorization
BlueCare Tennessee/CoverKids Prior Authorization List
High-Cost Lab Prior Authorization List
Ventilator Weaning and Sub-Acute Tracheal Suctioning Request
Bariatric Surgery Authorization Request Form
Complex Rehabilitation Technology DME Authorization Request
Durable Medical Equipment Request Form
Initial Member/Caregiver Training Checklist
Private Duty Nursing/Home Health Plan of Care
Private Duty Nursing Home Plan of Care Agreement
Recertification Member/Caregiver Training Checklist
Provider-Administered Specialty Pharmacy Products
Prior Authorization Request Form
Request Out of Network Benefits
Skilled Nursing Facility and Inpatient Rehabilitation Fax Form
Transplant Fax Form
MCG Site Guideline Transparency
Program-Specific Prior Authorization
Behavioral Health
Behavioral Health Out of Network Request Form
Mental Health Inpatient Request Form
Mental Health Outpatient Request Form
Psychiatric Residential Treatment Request Form
Psychological Testing Form
Provider Discharge Form
Referral for Applied Behavioral Analysis (ABA)
Request for Applied Behavioral Analysis (ABA)
Advanced Imaging
Advanced imaging includes many diagnostic tools, like CT, MRA, MRI and PET, that require prior authorization for BlueCare^SM patients. Please request authorization in Availity® or by calling 1-888-423-0131.
In-network providers caring for TennCareSelect members don’t have to get prior authorization. If you’re not an in-network provider, please contact our Utilization Management department at 1-800-711-4104.
High-Tech Imaging
High Tech Imaging Prior Authorization List
Pharmacy
Provider-Administered Specialty Pharmacy Products
TennCare Pharmacy Program

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Authorization Policies and Process

Appeals process

We’re committed to providing quality and cost-effective health care services to our members. Our decisions are based only on existence of coverage and appropriateness of care.

Before beginning the reconsideration and appeals process, treating providers can request a peer-to-peer discussion with a doctor to review details of the member’s condition and care options.

Parts of our authorization appeals process

Request a Reconsideration

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Appeal the Reconsideration

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Expedited Appeals
Expedited Appeals are available for members who are at a more urgent risk for severe health issues without the previously requested care or service.* To request an expedited appeal, please call Utilization Management at the appropriate number below. You can reach us Monday through Friday, 8 a.m. to 6 p.m. ET.
*Any care or service already provided isn’t considered for an expedited appeal.
BlueCare Utilization Management: 1-888-423-0131
TennCareSelect Utilization Management: 1-800-711-4104
CoverKids Utilization Management: 1-800-924-7141
CHOICES/ECF CHOICES: 1-888-747-8955
You can also submit a Treating Provider's Certificate: Expedited TennCare Appeal to the Division of TennCare at any point during the appeals process.
For information about filing an appeal for a value-based program, please see our Quality Care Initiatives page.

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Division of TennCare Member Appeal
If your patient has received a denial for services, your office can file an appeal for your patient to the Division of TennCare. Please note you must have approval from your patient, in writing, giving you permission to file the appeal.
Please submit written requests within 60 days of the denial by mail or fax:
TennCare Solutions Medical Appeals
P.O. Box 593
Nashville, TN 37202-0593
Fax: 1-888-345-5575

Authorization & Appeals

Provider Administration Manual

Prior Authorization Requests

Authorizations & Appeals

Services Requiring Authorization

Program-Specific Prior Authorization

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Authorization Policies and Process

Parts of our authorization appeals process

Request a Reconsideration

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Appeal the Reconsideration

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Expedited Appeals

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Division of TennCare Member Appeal

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Program-Specific Prior Authorization

Request a Reconsideration

Appeal the Reconsideration

Expedited Appeals

Division of TennCare Member Appeal

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