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 PDF icon to symbol the link is a pdf.

Cost-Effective Alternative Prior Authorization Form PDF icon to symbol the link is a pdf