Blue Cross and Blue Shield of Tennessee
Blue Cross and Blue Shield of Tennessee Prior Authorization
Prior authorization requirements vary by line of business and service type. In the commercial provider manual, prior authorization is required before…
Short answer
Prior authorization requirements vary by line of business and service type. In the commercial provider manual, prior authorization is required before scheduled services or within 2 business days of emergent services; Medicare Advantage timing is noted as 24…
Blue Cross and Blue Shield of Tennessee publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.
At a glance
- Prior authorization requirements vary by line of business and service type. In the commercial provider manual, prior authorization is required before scheduled services or within 2 business days of emergent services; Medicare Advantage timing is noted as 24 hours or next business day. Requests can be submitted in Availity e-Health Services, by phone, or by fax using the applicable form. The manual also states all inpatient stays require prior authorization, and some outpatient procedures do as well. The provider site directs providers to Availity for prior authorization requests across lines of business.
- Requirements differ by plan and service; self-funded arrangements may differ from insured plans.
- Some outpatient services do not require prior authorization, but may require it if performed inpatient.
- The commercial manual states prior auth requirements are listed on bcbst.com and a prior-auth PDF; the exact service-level list should be checked before submission.
Where to verify prior authorization requirements
How to submit prior authorization requests
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Availity e-Health Services / Availity portal
-
Phone
-
Fax
Information commonly required
- Member identification number and name
- Patient name and date of birth
- Practitioner name, provider number and/or NPI, address, telephone number, and caller name
- Facility/hospital name, provider number and/or NPI, address, telephone number, and caller name
- Procedure/operation to be performed, if applicable
- Diagnosis with supporting signs/symptoms
- Vital signs and abnormal lab results
- Elimination status
- Ambulatory status
- Hydration status
- Co-morbidities impacting the patient’s condition
- Complications
- Prognosis or expected length of stay
- Current medications
- Test results
Turnaround notes and caveats
- Authorization should be obtained prior to scheduled services or within 2 business days of emergent services.
- For requests needing additional information, if the requested information is not received by the end of the next calendar day, the request will be denied for lack of information.
- The manual notes a different timeframe for Medicare Advantage: 24 hours or next business day.
- Requirements differ by plan and service; self-funded arrangements may differ from insured plans.
- Some outpatient services do not require prior authorization, but may require it if performed inpatient.
- The commercial manual states prior auth requirements are listed on bcbst.com and a prior-auth PDF; the exact service-level list should be checked before submission.
Provider resources
- Manuals, Policies & Guidelines (official)
- Health Care Providers / Authorizations & Appeals (official)
- Coverage & Claims (official)
- Provider Contact Us (official)
- BlueCross BlueShield of Tennessee Provider Administration Manual (official)
- BlueCare Tennessee Provider Administration Manual (official)
- Claim Summary (official)
- Documents and Forms (official)
Sources
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Commercial manual prior auth timeframe and methods | When prior authorization is required, providers must obtain authorization prior to scheduled services or within two business days of emergent services. Prior authorization requests may be requested via e-Health Services in Availity, called in, or faxed. | Official | high |
| Commercial manual required information | Basic information needed includes member ID/name, patient name/DOB, practitioner and facility identifiers/contacts, plus clinical information such as diagnosis, vital signs, comorbidities, complications, prognosis, medications, and test results. | Official | high |
| Provider site Availity guidance | Providers can submit prior authorization requests for all lines of business 24/7 at Availity.com. | Official | high |
| Commercial manual inpatient/outpatient note | All inpatient stays require prior authorization; some outpatient procedures may require prior authorization depending on setting. | Official | medium |
Last reviewed: March 27, 2026
Sources used: 2 official
Automating prior authorization work
Clark Street Health is testing early-access workflows for requirements checks, status follow-up, document routing, and staff exceptions. Payer rules and clinical decisions still need the controls defined by your practice.
Review the prior authorization workflow