Section 1200-11-02-.05 - AUTHORIZATION AND REIMBURSEMENT FOR SERVICES(1) In-patient hospitalization must be prior approved when the Hemophilia Program is the primary payor.(2) No payment shall be made for services rendered to any participant who is receiving services under these Rules unless and until all third party payment sources available have been exhausted.(3) Dental services must have prior authorization and will be reimbursed based on the Schedule of Allowances of United Concordia Companies, Inc. (Blue Cross/Blue Shield of Pennsylvania).(4) With the exception of emergency services, all services provided under these Rules must be obtained within the State.Tenn. Comp. R. & Regs. 1200-11-02-.05
Original rule filed April 3, 1974, effective May 3, 1974. Amendment filed July 27, 1977, effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000.Authority: T.C.A. §§ 4-5-202, 53-5604, 68-41-102 and 68-41-104.