High Tech Imaging Authorization Request Form (BlueCross BlueShield of Tennessee Only)

In cases where you are unable to use the Cohere portal to submit your BlueCross BlueShield of Tennessee High Tech Imaging authorizations, please use the details below to submit a request by fax. 

Payer	Fax Information
BlueCross BlueShield of Tennessee	Click here to view and/or download fillable PDF High Tech Imaging Authorization Request fax form
	Send all completed documentation, with all supporting clinical documentation, by fax to Cohere Health.  Fax Number: [phone]

• Authorization Request Form - High Tech Imaging (2).pdf
  (900 KB)