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

Written by Nicole Saidai

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

BlueCross BlueShield of Tennessee

Send all completed documentation, with all supporting clinical documentation, by fax to Cohere Health.

  • Fax Number: (570) 595-4311

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