Tennessee

Prior authorization requirements can be bypassed for certain medications when specific medical conditions exist. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). See the lists of the preferred agents and the clinical criteria and see the list of Tennessee OptumRx Provider Liaisons.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.