Tenn. Comp. R. & Regs. 0800-02-17-.19 - PREAUTHORIZATION
(1) Preauthorization shall be required for
all non-emergency hospitalizations, non-emergency transfers between facilities,
and non-emergency surgery. Decisions regarding authorization shall be
communicated to the requesting provider within seven (7) business days of the
request being received. Failure to provide a timely decision within seven (7)
business days shall result in the authorization being deemed
approved.
(2) If a provider makes a
written request by fax or e-mail (and receives acknowledgement of receipt of
the request) for authorization for a treatment at least twenty-one (21)
business days in advance of the anticipated date that treatment is to be
delivered and has not been notified of a denial or modification in writing or
confirmed telephone call or confirmed fax at least seven (7) business days in
advance of the date of the proposed treatment, it is presumed to be medically
necessary, a covered service, and to be paid for by the employer.
(3) If a provider makes a verbal request for
authorization, the burden of proof for showing that authorization was granted
by the employer rests with the provider.
Notes
Authority: T.C.A. ยงยง 50-6-118, 50-6-125, 50-6-128, 50-6-204, and 50-6-205.
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