BCBS AFFILIATETNPBM: Express Scripts
BlueCross BlueShield of Tennessee Prior Authorization Guide
Submit prior authorization requests and appeal denials with BCBS Tennessee. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for TN providers.
Prior Authorization Contacts
PA PHONE
1-800-924-7141
PA FAX
1-423-535-1919
TURNAROUND
30 days standard, 72h expedited
TIMELY FILING
60 days
APPEALS MAILING ADDRESS
BCBS Tennessee, Attn: Appeals Dept, 1 Cameron Hill Circle, Chattanooga, TN 37402
Common Denial Reasons
- ⚠ Not meeting BCBS-T Medical Policy criteria
- ⚠ Step therapy required (Humira/Enbrel preferred over newer biologics)
- ⚠ Site of care — specialty infusions require home/office vs. hospital outpatient
- ⚠ Quantity limit exceeded
Step Therapy Requirements & Override Rights
BCBS Tennessee follows its Medical Policy Manual. For most biologics, requires 3-month trial of conventional DMARDs. For IL-17/IL-23 biologics in psoriasis, requires TNF inhibitor failure unless contraindicated. Tennessee enacted step therapy override legislation (2021) — physicians can request exceptions within 72 hours.
Tips for BCBS Tennessee Submissions
- 1. Use the BCBS-T Availity portal for PA submissions
- 2. Reference the exact Medical Policy number (found in BlueCross Medical Policy Manual)
- 3. Express Scripts handles pharmacy — specialty drugs go through Accredo
- 4. Tennessee's step therapy override law (Public Chapter 374) allows exceptions
External Review Authority
If BCBS Tennessee denies your final internal appeal, you have the right to request an external review through: Tennessee Department of Commerce and Insurance (within 4 months).
External review decisions are binding on the insurer.