Tennessee Health Carrier Grievance and External Review Procedure Act

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  2. Tennessee Code
  3. Insurance
  4. Tennessee Health Carrier Grievance and External Review Procedure Act

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Section
56-61-101

Short Title — Purpose

Section
56-61-102

Chapter Definitions

Section
56-61-103

Applicability and Scope

Section
56-61-104

No Limitations or Restrictions on Denying Coverage of Services Not Medically Necessary

Section
56-61-105

Maintenance of Register of Written Records to Document Grievances

Section
56-61-106

Written Procedures for Grievances

Section
56-61-107

First Level Review of Adverse Determination

Section
56-61-108

Second Level Review of Adverse Determination

Section
56-61-109

Establishment of Written Procedures for Expedited Review of Urgent Care Requests of Grievances Involving Adverse Determination

Section
56-61-110

Rules and Regulations

Section
56-61-111

Penalties for Violations

Section
56-61-112

Elections for Conducting External Review Program

Section
56-61-113

Notice of Right to External Review

Section
56-61-114

Request for External Review

Section
56-61-115

Exhaustion of Internal Grievance Process

Section
56-61-116

Standard External Review

Section
56-61-117

Expedited External Review

Section
56-61-118

Requests for External Review When Service or Treatment Determined to Be Investigational

Section
56-61-119

Binding Nature of External Review Decisions

Section
56-61-120

Approval of External Review Organizations

Section
56-61-121

Minimum Qualifications for Independent Review Organizations

Section
56-61-122

Hold Harmless for External Review Organizations

Section
56-61-123

External Review Reporting Requirements

Section
56-61-124

Funding of External Review

Section
56-61-125

Disclosure Requirements