Skip to Content

Cost-Effective Alternative Prior Authorization Form

This form is for use by a TennCare Managed Care Organization (MCO) seeking to provide a cost-effective alternative service to a TennCare enrollee. Note that prior approval from TennCare is required only if the cost-effective alternative service in question is not on the list of pre-approved services in Policy BEN 08-001. (See http://www.tn.gov/tenncare/forms/ben08001.pdf.)

Cost-Effective Alternative Prior Authorization Form