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