CurrentBlue Cross Blue Shield - TennesseePolicy N/A

Commercial Prior Authorizations Start & Term Date

Lists effective (start) dates and term (end) dates, plus comments, for commercial prior authorization requirements across many services and settings; applies to Blue Cross Blue Shield - Tennessee commercial plans and impacts providers requesting prior authorizations.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyCommercial Prior Authorizations Start & Term Date

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionCheck the listed effective and term dates and verify group-specific benefits to determine whether prior authorization is required for a requested service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~60+distinct services/settings listed with dates/comments

multipleplaceholder historic effective date entries

severalitems with explicit term date = 5/1/2024

manyitems with group-specific PA note

Prior Authorization Dates and Comments

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyCommercial Prior Authorizations Start & Term Date

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionCheck the listed effective and term dates and verify group-specific benefits to determine whether prior authorization is required for a requested service.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

List of services with their Prior Authorization effective date, term (end) date, and any comments as provided in the table.

Examples

Hysterectomy (standalone): Effective = 7/5/2011; Term Date of PA = 5/1/2024; Comments = .
Varicose Vein Procedures: Effective = 7/5/2011; Term Date of PA = 5/1/2024; Comments = .
23 hour Observation (elective, direct admit from MD, or transfers): Effective = 1/1/1900; Term Date of PA = 5/1/2024; Comments = .
Transplants: Effective = 1/1/1900; Term Date of PA = [not specified]; Comments = .
Non-Emergent Air Ambulance Transportation: Effective = 1/1/2018; Term Date of PA = [not specified]; Comments = .
Hyperbaric Treatments: Effective = 6/30/2014; Term Date of PA = [not specified]; Comments = .
Pain Management: Effective = 3/1/2012; Term Date of PA = [not specified]; Comments = Please check benefits to determine group-specific prior authorization requirements.
Neuropsychological Testing: Effective = 1/1/2012; Term Date of PA = [not specified]; Comments = .
Spine Surgery: Effective = 3/1/2012; Term Date of PA = [not specified]; Comments = Please check benefits to determine group-specific prior authorization requirements.
Joint Surgery (Hip, Knee, Shoulder): Effective = 3/1/2012; Term Date of PA = [not specified]; Comments = Please check benefits to determine group-specific prior authorization requirements.

Codes and DME Thresholds

Not specifiedmixed

DME dollar thresholds (notifications from policy brief and source text)

DME greater than $500Entry listed in thresholds summary (DME > $500) with effective date present in document

DME greater than $1,000DME >$1,000 appears in the policy listing with associated comments (chunk shows 'DME >$1,000, Comments = .')

Effective dates for DME thresholdsEffective dates for DME thresholds are provided in the document listing (see DME line) — providers should refer to the listed effective date for the specific threshold

Provider Guidance and Actionable Dates

Prior Authorization

Prior authorization start and term dates listing

This table lists services with their prior authorization effective and term dates to guide when a PA is required (examples shown). Providers must use these dates to determine whether a PA is in effect for the service requested.

Inpatient Admissions — Effective = 1/1/1900; Term Date of PA = (none listed).
Neonatal ICU Admissions — Effective = 5/1/2011; Term Date of PA = (none listed).
Endometrial Ablation — Effective = 7/5/2011; Term Date of PA = (none listed).
Bariatric Surgery — Effective = 7/5/2011; Term Date of PA = (none listed).
Panniculectomy — Effective = 7/5/2011; Term Date of PA = (none listed).
Blepharoplasty/Browplasty — Effective = 7/5/2011; Term Date of PA = (none listed).
Breast Surgery for Augmentation or Reduction — Effective = 7/5/2011; Term Date of PA = (none listed).

Documentation Required

Term dates and benefit-check comments

Certain services have explicit term (end) dates and many entries include a comment instructing providers to check group-specific benefits for PA requirements.

Hysterectomy (standalone) — Effective = 7/5/2011; Term Date of PA = 5/1/2024.
Varicose Vein Procedures — Effective = 7/5/2011; Term Date of PA = 5/1/2024.
23 hour Observation (elective, direct admit from MD, or transfers) — Effective = 1/1/1900; Term Date of PA = 5/1/2024.
Many services (e.g., Pain Management, Spine Surgery, Joint Surgery) include the comment: 'Please check benefits to determine group-specific prior authorization requirements.'

Prior Authorization

Behavioral health prior auth entries

Behavioral health services and related therapies are listed with their effective dates; some behavioral services have explicit term dates.

Residential Treatment (RES) — Effective = 1/1/1900; Term Date of PA = (none listed).
Partial Hospitalization (PHP) — Effective = 1/1/1900; Term Date of PA = (none listed).
Intensive Outpatient Program (IOP) — Effective = 1/1/1900; Term Date of PA = (none listed).
Transcranial Magnetic Stimulation (TMS) — Effective = 4/1/2015; Term Date of PA = (none listed).
Neuropsychological Testing — Effective = 1/1/2021; Term Date of PA = (none listed).
Applied Behavior Analysis (ABA) — Effective = 1/1/2018 (FEP 1/1/2017); Term Date of PA = (none listed).
Electroconvulsive Therapy (ECT) — Effective = 1/1/1900; Term Date of PA = 5/1/2024.

Date Fields Definitions

Effective (definition)

Definition (Effective)The 'Effective' field denotes the start date when the prior authorization requirement for the listed service became effective (e.g., Inpatient Admissions, Effective = 1/1/1900).

PurposeMarks the date from which PA requirements apply for the service; used to determine whether an authorization timeframe is governed by this policy.

Source guidanceEffective dates are listed per service in the 'Commercial Prior Authorizations Start & Term Date' table within the document.

Term Date (definition)

Definition (Term Date)The 'Term Date' field indicates the end date of the prior authorization requirement for the listed service (many entries show 'Term Date of PA = .' when no end date is specified; some services have explicit term dates).

Interpretation when blankA blank 'Term Date of PA' in the listing signifies that no specific termination date is recorded in the table for that service.

Action for providersWhen Term Date is blank or unclear, providers should check group-specific benefits or current policy communications to confirm whether PA is still required.