This text of Tennessee § 56-7-3702 (Part definitions) is published on Counsel Stack Legal Research, covering Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
As used in this part:
(1)"Additional business day" means the first weekday not designated as a state or federal holiday;
(2)"Adverse determination" has the same meaning as defined in § 56-61-102 ;
(3)"Chronic condition" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both;
(4)"Commissioner" has the same meaning as defined in § 56-1-102 ;
(5)"Emergency healthcare services" means emergency services as defined in § 56-7-2355 ;
(6)"Enrollee" has the same meaning as defined in § 56-6-703 ;
(7)"Enrollee benefit plan" means the right to have a payment made by a health carrier for a prescription drug listed on the applicable formulary or healthcare services in accordance with coverage con
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As used in this part: (1) "Additional business day" means the first weekday not designated as a state or federal holiday; (2) "Adverse determination" has the same meaning as defined in § 56-61-102 ; (3) "Chronic condition" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both; (4) "Commissioner" has the same meaning as defined in § 56-1-102 ; (5) "Emergency healthcare services" means emergency services as defined in § 56-7-2355 ; (6) "Enrollee" has the same meaning as defined in § 56-6-703 ; (7) "Enrollee benefit plan" means the right to have a payment made by a health carrier for a prescription drug listed on the applicable formulary or healthcare services in accordance with coverage contained within a health benefit plan delivered, issued for delivery, or renewed in this state; (8) "Facility" means an institution licensed under title 33 or 68; (9) "Health carrier" has the same meaning as defined in § 56-61-102 ; (10) "Healthcare prescriber" means a prescriber as defined in § 53-10-203 ; (11) "Healthcare professional" has the same meaning as defined in § 56-61-102 ; (12) "Healthcare provider" has the same meaning as defined in § 56-61-102 ; (13) "Healthcare service" means a service rendered by a healthcare provider or at a practice that provides testing, monitoring, diagnosis, or treatment of a human disease or condition, or dispenses medical devices, medical appliances, or medical goods for the treatment of a human disease or condition; (14) "Inpatient service" means care provided in a hospital or other type of inpatient facility where an individual is admitted and spends one (1) or more nights, depending on the individual's medical condition; (15) "Medically necessary" or "medical necessity" has the same meaning as defined in § 56-61-102 ; (16) "Physician" means a medical doctor or osteopathic physician with a valid state medical license issued pursuant to title 63, chapter 6 or 9; (17) "Practice" means an entity formed with at least one (1) healthcare provider to provide healthcare services; (18) "Prescription drug" has the same meaning as defined in § 56-7-3201 ; (19) "Prior authorization" means a written or oral determination made by a health carrier or utilization review organization, or an agent of such carrier or organization, that an enrollee's receipt of a healthcare service is a covered benefit under the applicable plan and that a requirement of medical necessity or other requirements imposed by such utilization review organization as prerequisites for payment for such services have been satisfied; (20) "Urgent care request" has the same meaning as defined in § 56-61-102 ; and (21) "Utilization review organization" means: (A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier; and (B) A health maintenance organization, or another individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, behavioral health, prescription drug, or other health benefits to a person treated by a healthcare provider in this state under a health insurance policy, plan, or contract.