CurrentBlue Cross Blue Shield - TennesseePolicy N/A

Commercial Prior Authorization List

Lists services that may require prior authorization for BlueCross BlueShield of Tennessee commercial plans and provides submission channels and contact information for providers.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyCommercial Prior Authorization List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionIn-state providers should submit prior authorization requests and verify benefits through Availity; out-of-state providers may submit via Cohere.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~50+listed services or service categories requiring prior auth

1central phone number for general questions

2provider submission portals named

Services Requiring Prior Authorization

Prior authorization-required services (summary)

Services that may require prior authorization for commercial plans (inpatient or outpatient):

ALL of the following

Inpatient and facility-based services
- Inpatient Admissions
- Neonatal ICU Admissions
- Long-Term Acute Care
- Skilled Nursing Facilities

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyCommercial Prior Authorization List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionIn-state providers should submit prior authorization requests and verify benefits through Availity; out-of-state providers may submit via Cohere.

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.

Submitting Prior Authorization Requests

Prior Authorization

Prior authorization requirement overview

Prior authorization may be required for commercial plans for the services listed in this document for inpatient or outpatient settings; providers must check group-specific benefits to determine whether prior authorization is required for a particular member.

Applies to services listed (e.g., inpatient admissions, neonatal ICU, transplants, select surgeries, behavioral health services, DME > $1,000).
Providers must check member group benefits for specific prior authorization requirements.

Prior Authorization

How to submit prior authorization requests

In-state providers may request prior authorization, confirm coverage, and verify benefits through Availity. Out-of-state providers may submit authorization requests via Cohere (coherehealth.com).

Use Availity to submit and manage prior authorization requests for in-state providers.
Out-of-state providers may submit authorization requests at any time via Cohere.

Documentation Required

Contact information

For assistance with submitting prior authorizations in Availity or Cohere call (423) 535-5717, option 2, or contact your eBusiness Regional Marketing Consultant; for other questions call 1-800-924-7141.

Prior authorization submission support: (423) 535-5717, option 2.
General inquiries: 1-800-924-7141.

Definitions and Submission Portals

Prior Authorization List — Services That May Require Prior Authorization

Scope — inpatient and outpatientServices listed may require prior authorization for commercial plans in either inpatient or outpatient settings; check group benefits for specifics.

Selected service categoriesInpatient admissions, Neonatal ICU, Long-Term Acute Care, Skilled Nursing Facilities, Inpatient Rehabilitation, Hospice (Inpatient only), Transplants, Gender Reassignment Surgery, Breast Surgery (augmentation/reduction), Endometrial Ablation.

Behavioral health & therapiesBehavioral Health services including inpatient admissions, Residential Treatment (RES), Partial Hospitalization (PHP), Intensive Outpatient Program (IOP), Transcranial Magnetic Stimulation (TMS); also therapies and testing such as Speech/Occupational/Physical Therapy, Psychological/Neuropsychological Testing, Applied Behavior Analysis (ABA).

Additional procedures and servicesSpine and joint surgery, pain management (interventional), bariatric surgery, panniculectomy, blepharoplasty/browplasty (color photos required), high‑tech imaging, radiation oncology therapy program, genetic testing, lab sleep studies (18+), hyperbaric treatments, non‑emergent air ambulance, specialty pharmacy drugs, home health visits.

Submission Portals for Prior Authorization

In‑state providersUse Availity to request prior authorization, confirm coverage, and verify benefits.

Out‑of‑state providersSubmit authorization requests via Cohere at coherehealth.com.

SupportIf you have questions about submitting a prior authorization in Availity or Cohere, call (423) 535-5717, option 2; other questions call 1-800-924-7141.

OpenPayer

Commercial Prior Authorization List

Services Requiring Prior Authorization

Coding and Thresholds

Submitting Prior Authorization Requests

Definitions and Submission Portals