Tennessee program
Deadlines for a treatment approval (prior authorization)
Tennessee sets response deadlines for treatment approval requests and appeals on plans covered by its law.
What it is
Tennessee sets response deadlines for treatment approval requests and appeals on plans covered by its law.
When a treatment request is waiting for an answer, the plan type and review stage matter. Tennessee has different clocks for initial requests and appeals. The oncology team can explain whether the medical situation makes the request urgent.
Eligibility rules
- The adopted law takes effect January 1, 2025. It covers the insurers and state health plans named in its text.
- It expressly excludes TennCare, CoverKids, policies under TennCare contracts and plans governed only by federal employee-benefit law.
- This law covers the insurers and state health plans named in its text. It excludes TennCare, CoverKids, TennCare-contract coverage and plans governed exclusively by ERISA. A public employer’s self-funded plan needs its own legal-scope check. Your plan administrator confirms the category and rules for a teacher, municipal or other public plan.
What you get
- A deadline for the plan’s response under the rules that apply to it.
- An urgent appeal clock of 72 hours on plans covered by this state law.
What the help covers
- The framework effective January 1, 2025 sets a seven-calendar-day first response for nonurgent initial requests. The whole initial process has a 17-day limit, with intermediate steps. Covered electronic appeals generally have seven calendar days for nonurgent cases and 72 hours for urgent cases.
- Within seven days the plan must approve, refuse or say what is missing. Once the clinic sends the missing piece, the plan has five more days, and the whole process may not run past 17 days.
- An unanswered nonurgent initial request can be treated as approved only when the law’s conditions are met. The plan and oncology team can check those conditions.
If you decide to apply
- Ask your plan which deadline applies and when it received the complete request.
- Ask the oncology team to document urgency when appropriate, and keep the plan’s written reply.
Your health plan; Tennessee Consumer Insurance Services: 1-800-342-4029. · Official page ↗
After you ask
- The insurance department can discuss complaints about a covered plan: 1-800-342-4029.
Good to know
Initial requests and appeals have different steps, and seven days matters on both tracks. The team can identify the request date, submission method, urgency and controlling deadline.
Other details
- For TennCare, the plan and TennCare medical appeal rules govern instead. Member medical appeals: 1-800-878-3192.
Official sources
“Which response deadline applies to our treatment request, and should the team mark it urgent? Could you help us understand the appeal route if the plan misses the deadline or says no?”
Why I’m asking: I want to know when an answer is due so a paperwork delay does not disrupt care.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask in writing which deadline applies and when the clock started, and keep the reply.
Your social worker
The oncology team marks a request urgent when it is, which is what starts the faster clock.
The care team
Records and letters when the application asks for them.
- Who decides
- Your health plan.
- Ask the agency
- “Which deadline applies to this prior authorization under Tennessee law, when did the clock start, and is this being treated as urgent?”
How to apply
First step: Ask the plan in writing which deadline applies to the pending request and when the clock started.
- Ask the plan in writing which deadline applies to the request and when it started.
- If a parent is on a state, teacher or municipal plan, ask human resources whether Tennessee insurance law reaches it.
Official application / program page ↗
Where it starts: Ask the plan in writing which deadline applies and when the clock started. If it will not answer, call the insurance department on 1-800-342-4029.
What to gather
- The insurance card and plan documents
- The date the request was sent and by whom
- Anything the plan has sent back
How long: For requests covered by the law effective January 1, 2025: initial response within seven calendar days, then five after required information, with a 17-day overall initial limit. Electronic appeals have seven-day or urgent 72-hour limits, subject to submission rules and shorter applicable federal limits.
What a yes looks like
A written answer naming the deadline and the date it started.
What a no looks like, and the next move
If the plan says Tennessee law does not reach it, ask which law does, and call the insurance department on 1-800-342-4029.
Watch out
- The seven-day and 72-hour clocks sit in the appeal section. A first request runs on a different track.
- TennCare and CoverKids are excluded from this state prior-approval law. TennCare has a separate centralized medical-appeal process and deadlines.
- If a parent is on a government, teacher or state employee plan, ask human resources in writing whether Tennessee insurance law applies.
If they say no, quote this: The adopted text says the part applies to insurers providing healthcare plans and to state healthcare plans, while excluding plans governed only by federal employee-benefit law, TennCare and CoverKids.
Dates that change this
2025-01-01: The adopted 2023 text was read and gives the January 1, 2025 start date, but the enrolled act could not be opened, so later amendments are unverified. Ask the plan to state its own current deadline in writing. (not yet confirmed against the final rule)
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Deadlines on a Tennessee-regulated plan: seven calendar days and 72 hours on the appeal track, and a seventeen-day limit on the first-request process.
- $7 — Non-urgent review deadline on the appeal track
- $72 — Urgent review deadline on the appeal track
- $17 — Limit on the whole first-request process
Legal protection: A first request that is not urgent and is not answered can be treated as approved under the conditions the law sets · The law names the plans it covers and the ones it leaves out
What it costs the family: None.
The eligibility facts, as published
- Plans covered
- insurers providing health care plans, and state health care plans, as the adopted text sets out
- Plans excluded
- plans governed only by federal employee-benefit law, policies under a TennCare contract, TennCare and CoverKids
- Unknown
- individual teacher and municipal plans
- Effective
- 2025-01-01 in the adopted text
The trap: These deadlines are not all the same clock. Seven calendar days and 72 hours sit in the section about appealing, while a first request runs on a different track with a deemed-approval rule and a limit of seventeen calendar days on the whole process. Ask the plan which one your request is on.
Where I read this
- Adopted amendment HA0265 to the Prior Authorization Fairness Act — Tennessee General Assembly, read September 10, 2026
- SB0666 and HB0885 legislative history — Tennessee General Assembly, read September 10, 2026
- Consumer resources, Consumer Insurance Services — Tennessee Department of Commerce and Insurance, read September 10, 2026