Referrals and preapprovals in TN


For some Tennessee Medicaid services, you’ll need a referral from your primary care provider (PCP) before getting care.

When to get a referral


You’ll need to get a referral from your PCP before:


Meeting with a specialist.


Going to a hospital for nonemergency care.


Getting certain medicines, tests, and services.


Self-referral services


For most services, you'll go to your PCP or another provider in our plan. But there are some services we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.


You don’t need a referral from your PCP for:


Emergency care


Yearly OB-GYN exams and prenatal care


Behavioral health care from a provider in our plan


TennCare Kids screenings

You may need preapproval for a service


A preapproval is when your doctor asks us to approve a service before you receive it. Your PCP will work with us to get the preapprovals you need.


Your PCP will need to send preapproval for:


Planned inpatient admissions


Certain behavioral health services


Certain prescriptions


Rehabilitation therapies


Home health services


Pain management

Have questions?


Check your member handbook or live chat with a representative through the online portal or the Sydney Health app.