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January/February 2025 Top of Mind
New online submission process for Commercial prior authorization requests
Can you say convenience?
That’s what you get with Tennessee’s new online process for submitting most Commercial prior authorization requests.
Beginning Jan. 1, 2025, out-of-network behavioral health providers can now use the standard Tennessee online prior authorization form* for most levels of care. This applies for members covered by Commercial health plans only.
ACTION: Save the link to the standardized prior authorization form
When you complete the form, be sure to fill in all fields marked mandatory. Once you submit the completed form, you’ll see a confirmation page.
Process exception for IOP, PHP and residential
The Provider Express secure portal should continue to be used to request authorization for inpatient, residential or partial hospitalization services:
Log in to the Provider Express secure portal with your One Healthcare ID and password, then:
- Select Auth option from the menu
- Choose Review Online
- Complete the request
We encourage network (contracted) providers to continue using the Provider Express secure portal to submit prior authorization requests, as you do today.
You can move seamlessly within the portal to submit the authorization as well as complete other claim-related tasks, such as checking member eligibility, verifying claim status and submitting corrected claims. The Provider Express secure portal is your administrative task time saver!
Have questions?
Simply call the number on the back of the member’s ID card.
*Submitting the online prior authorization form doesn’t guarantee authorization of your request.
