Tennessee Providers

Precertification requirements


To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, and then choose Authorizations or Auth/Referral Inquiry, as appropriate.

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Behavioral health

Please submit all precertification requests through our preferred method at Availity.com

If you prefer to paper fax, please submit correct forms to:

Inpatient:

1-844-452-8071

Outpatient:

1-866-920-6006

Services billed with the following revenue codes always require precertification:

0240 to 0249 all-inclusive ancillary psychiatric
0901, 0905 to 0907, 0913, 0917 behavioral health treatment services
0944 to 0945 other therapeutic services
0961 psychiatric professional fees

Pharmacy

Check our Preferred Drug List .

Services billed with the following revenue code always require precertification:

0632 pharmacy multiple sources

Medicare/ Long-Term Services and Supports (LTSS) program

Medicare

Precertification is not required for physician evaluation and management services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports (LTSS) program

Providers needing an authorization should email us at ltcprovreq@wellpoint.com or call 1-866-840-4991.

Call:

1-866-840-4991

The following always require precertification:

  • Elective services provided by or arranged at nonparticipating facilities
  • All services billed with the following revenue codes:
0023 home health prospective payment system
0570 to 0572, 0579 home health aide
0944 to 0945 other therapeutic services
3101 to 3109 adult day and foster care

Email:

ltcprovreq@wellpoint.com

Provider tools & resources

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We look forward to working with you to provide quality services to our members.