{"data":{"id":"us-tn/tenn.-code-ann.-56-7-3702","jurisdiction":"us-tn","citation":"Tenn. Code Ann. § 56-7-3702","heading":"Part definitions","body":"As used in this part: (1) \"Additional business day\" means the first weekday not designated as a state or federal holiday; (2) \"Adverse determination\" has the same meaning as defined in § 56-61-102 ; (3) \"Chronic condition\" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both; (4) \"Commissioner\" has the same meaning as defined in § 56-1-102 ; (5) \"Emergency healthcare services\" means emergency services as defined in § 56-7-2355 ; (6) \"Enrollee\" has the same meaning as defined in § 56-6-703 ; (7) \"Enrollee benefit plan\" means the right to have a payment made by a health carrier for a prescription drug listed on the applicable formulary or healthcare services in accordance with coverage contained within a health benefit plan delivered, issued for delivery, or renewed in this state; (8) \"Facility\" means an institution licensed under title 33 or 68; (9) \"Health carrier\" has the same meaning as defined in § 56-61-102 ; (10) \"Healthcare prescriber\" means a prescriber as defined in § 53-10-203 ; (11) \"Healthcare professional\" has the same meaning as defined in § 56-61-102 ; (12) \"Healthcare provider\" has the same meaning as defined in § 56-61-102 ; (13) \"Healthcare service\" means a service rendered by a healthcare provider or at a practice that provides testing, monitoring, diagnosis, or treatment of a human disease or condition, or dispenses medical devices, medical appliances, or medical goods for the treatment of a human disease or condition; (14) \"Inpatient service\" means care provided in a hospital or other type of inpatient facility where an individual is admitted and spends one (1) or more nights, depending on the individual's medical condition; (15) \"Medically necessary\" or \"medical necessity\" has the same meaning as defined in § 56-61-102 ; (16) \"Physician\" means a medical doctor or osteopathic physician with a valid state medical license issued pursuant to title 63, chapter 6 or 9; (17) \"Practice\" means an entity formed with at least one (1) healthcare provider to provide healthcare services; (18) \"Prescription drug\" has the same meaning as defined in § 56-7-3201 ; (19) \"Prior authorization\" means a written or oral determination made by a health carrier or utilization review organization, or an agent of such carrier or organization, that an enrollee's receipt of a healthcare service is a covered benefit under the applicable plan and that a requirement of medical necessity or other requirements imposed by such utilization review organization as prerequisites for payment for such services have been satisfied; (20) \"Urgent care request\" has the same meaning as defined in § 56-61-102 ; and (21) \"Utilization review organization\" means: (A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier; and (B) A health maintenance organization, or another individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, behavioral health, prescription drug, or other health benefits to a person treated by a healthcare provider in this state under a health insurance policy, plan, or contract. Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.\nAs used in this part:\n(1) \"Additional business day\" means the first weekday not designated as a state or federal holiday;\n(2) \"Adverse determination\" has the same meaning as defined in § 56-61-102 ;\n(3) \"Chronic condition\" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both;\n(4) \"Commissioner\" has the same meaning as defined in § 56-1-102 ;\n(5) \"Emergency healthcare services\" means emergency services as defined in § 56-7-2355 ;\n(6) \"Enrollee\" has the same meaning as defined in § 56-6-703 ;\n(3) \"Chronic condition\" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both;\n(4) \"Commissioner\" has the same meaning as defined in § 56-1-102 ;\n(5) \"Emergency healthcare services\" means emergency services as defined in § 56-7-2355 ;\n(6) \"Enrollee\" has the same meaning as defined in § 56-6-703 ;\n(7) \"Enrollee benefit plan\" means the right to have a payment made by a health carrier for a prescription drug listed on the applicable formulary or healthcare services in accordance with coverage contained within a health benefit plan delivered, issued for delivery, or renewed in this state;\n(8) \"Facility\" means an institution licensed under title 33 or 68;\n(9) \"Health carrier\" has the same meaning as defined in § 56-61-102 ;\n(10) \"Healthcare prescriber\" means a prescriber as defined in § 53-10-203 ;\n(11) \"Healthcare professional\" has the same meaning as defined in § 56-61-102 ;\n(12) \"Healthcare provider\" has the same meaning as defined in § 56-61-102 ;\n(13) \"Healthcare service\" means a service rendered by a healthcare provider or at a practice that provides testing, monitoring, diagnosis, or treatment of a human disease or condition, or dispenses medical devices, medical appliances, or medical goods for the treatment of a human disease or condition;\n(14) \"Inpatient service\" means care provided in a hospital or other type of inpatient facility where an individual is admitted and spends one (1) or more nights, depending on the individual's medical condition;\n(15) \"Medically necessary\" or \"medical necessity\" has the same meaning as defined in § 56-61-102 ;\n(16) \"Physician\" means a medical doctor or osteopathic physician with a valid state medical license issued pursuant to title 63, chapter 6 or 9;\n(17) \"Practice\" means an entity formed with at least one (1) healthcare provider to provide healthcare services;\n(18) \"Prescription drug\" has the same meaning as defined in § 56-7-3201 ;\n(19) \"Prior authorization\" means a written or oral determination made by a health carrier or utilization review organization, or an agent of such carrier or organization, that an enrollee's receipt of a healthcare service is a covered benefit under the applicable plan and that a requirement of medical necessity or other requirements imposed by such utilization review organization as prerequisites for payment for such services have been satisfied;\n(20) \"Urgent care request\" has the same meaning as defined in § 56-61-102 ; and\n(21) \"Utilization review organization\" means: (A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier; and (B) A health maintenance organization, or another individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, behavioral health, prescription drug, or other health benefits to a person treated by a healthcare provider in this state under a health insurance policy, plan, or contract.\n(A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier; and\n(B) A health maintenance organization, or another individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, behavioral health, prescription drug, or other health benefits to a person treated by a healthcare provider in this state under a health insurance policy, plan, or contract.","path":["TN Code","Title 56","Chapter 7"],"source_url":"https://oss-data-us.vaquill.ai/v2026.08/us_tn_statutes.parquet","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:26Z","sha256":"337983222efd201ff876fbcdd244ddd50f25388d5a642a7a40dbfd38c0ee7e68","source_id":"us-tn","stale":false,"prev":"us-tn/tenn.-code-ann.-56-7-3701","next":"us-tn/tenn.-code-ann.-56-7-3703"},"notice":"GroundRules: Original legal text. Not legal advice."}