Tenn. Code Ann. § 63-1-171: Notification of communication concerning additional information needed to process prior authorization request for patient

(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 of commerce and insurance, 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 title 68, chapter 11; 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 this title or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract. (b) Except as provided in subsection (d), a provider shall notify a patient of communication between the provider and a health insurance entity or healthcare facility 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 provider shall notify the patient via electronic means, such as by email or through an online patient portal offered by the provider, unless the patient requests, in writing, an alternative notification method. (d) If the patient is a minor, then the provider 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. Added by 2022 Tenn. Acts, ch. 664, s 5, eff. 1/1/2023.

(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 of commerce and insurance, 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 title 68, chapter 11; 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 th

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 this title or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract.

(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 of commerce and insurance, 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 title 68, chapter 11; and (B) Excludes emergency room and in-patient services provided at a hospital, as defined in § 68-11-201 ;

(A) Means an institution, place, or building providing healthcare services that is required to be licensed under title 68, chapter 11; 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 this title or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract.

(b) Except as provided in subsection (d), a provider shall notify a patient of communication between the provider and a health insurance entity or healthcare facility 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 provider shall notify the patient via electronic means, such as by email or through an online patient portal offered by the provider, unless the patient requests, in writing, an alternative notification method.

(d) If the patient is a minor, then the provider 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.