Tennessee § 68-11-245 Notification of communication concerning additional information needed to process prior authorization request for patient

Tennessee Statutes

§ 68-11-245 — Notification of communication concerning additional information needed to process prior authorization request for patient

Tennessee § 68-11-245

Title68

This text of Tennessee § 68-11-245 (Notification of communication concerning additional information needed to process prior authorization request for patient) 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.

Bluebook

Tenn. Code Ann. § 68-11-245 (2026).

Text

(a)As used in this section:

(1)"Communication" means written or electronic correspondence among a healthcare facility, health insurance entity, or provider concerning a prior authorization;

(2)"Health insurance coverage" has the same meaning as defined in § 56-7-109 ;

(3)"Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, and a nonprofit hospital and medical service corporation;

(4)"Healthcare facility":

(A)Means an institution, place, or building providing healthcare services that is required to be licensed under this chapter; and (B) Ex

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(a) As used in this section: (1) "Communication" means written or electronic correspondence among a healthcare facility, health insurance entity, or provider concerning a prior authorization; (2) "Health insurance coverage" has the same meaning as defined in § 56-7-109 ; (3) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, and a nonprofit hospital and medical service corporation; (4) "Healthcare facility": (A) Means an institution, place, or building providing healthcare services that is required to be licensed under this chapter; and (B) Excludes emergency room and in-patient services provided at a hospital as defined in § 68-11-201 ; (5) "Healthcare service" means a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease; (6) "Minor" means an individual who has not attained eighteen (18) years of age; (7) "Policyholder" means an individual who has contracted with a health insurance entity for healthcare services coverage; and (8) "Provider" means an individual or entity performing services regulated pursuant to title 63 or this chapter, with whom the health insurance entity has an express and valid network provider agreement or contract. (b) Except as provided in subsection (d), a healthcare facility shall notify a patient of communication between the healthcare facility and a health insurance entity or provider concerning additional information needed to process a prior authorization request for the patient within five (5) business days after the communication has occurred. The notification must include a brief summary of the communication or a copy of the communication. (c) The healthcare facility shall notify the patient via electronic means, such as by email or through an online patient portal offered by the healthcare facility, unless the patient requests, in writing, an alternative notification method. (d) If the patient is a minor, then the healthcare facility must notify the policyholder whose health insurance coverage covers the minor. (e) This section does not apply to the TennCare program or a successor to the program provided for in the Medical Assistance Act of 1968, compiled in title 71, chapter 5, or to the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11 or a successor program.