Tennessee Notice of Appeal Rights for a Utilization Review Denial

• Category: Tennessee Workers Compensation - Official
• State: Tennessee
• Control #: TN-SKU-1628
• Format: PDF

Description

Notice of Appeal Rights for a Utilization Review Denial Tennessee Notice of Appeal Rights for a Utilization Review Denial is a notification of a patient’s right to appeal a health plan’s decision to deny a request for medical services, tests, or procedures. It is required by the Tennessee Department of Commerce and Insurance to inform a patient of their right to appeal a denial decision from a utilization review. The notice is sent to the patient within 15 days of the denial decision. There are two types of Tennessee Notice of Appeal Rights for a Utilization Review Denial: 1) External Review Appeal and 2) Internal Appeal of the Utilization Review Denial. The External Review Appeal allows the patient to request an external review from a third-party organization. The patient must file the appeal within 60 days of receiving the notice and must include any additional information necessary to support the appeal. The external review organization will review the case and make a decision on the appeal. The Internal Appeal of the Utilization Review Denial is an internal appeal process through the health plan. The patient must file the appeal within 60 days of receiving the notice and must include any additional information necessary to support the appeal. The health plan will review the case and make a decision on the appeal. Both types of appeals must include the patient’s name, date of birth, health plan identification number, and a detailed description of the denial decision and the reason for the appeal. The notice also provides information on how to contact the health plan and the external review organization for more information.

Tennessee Notice of Appeal Rights for a Utilization Review Denial is a notification of a patient’s right to appeal a health plan’s decision to deny a request for medical services, tests, or procedures. It is required by the Tennessee Department of Commerce and Insurance to inform a patient of their right to appeal a denial decision from a utilization review. The notice is sent to the patient within 15 days of the denial decision. There are two types of Tennessee Notice of Appeal Rights for a Utilization Review Denial: 1) External Review Appeal and 2) Internal Appeal of the Utilization Review Denial. The External Review Appeal allows the patient to request an external review from a third-party organization. The patient must file the appeal within 60 days of receiving the notice and must include any additional information necessary to support the appeal. The external review organization will review the case and make a decision on the appeal. The Internal Appeal of the Utilization Review Denial is an internal appeal process through the health plan. The patient must file the appeal within 60 days of receiving the notice and must include any additional information necessary to support the appeal. The health plan will review the case and make a decision on the appeal. Both types of appeals must include the patient’s name, date of birth, health plan identification number, and a detailed description of the denial decision and the reason for the appeal. The notice also provides information on how to contact the health plan and the external review organization for more information.