Tenn. Comp. R. & Regs. 1200-13-16-.08

Current through September 10, 2024

Section 1200-13-16-.08 - RIGHT TO APPEAL A MEDICAL NECESSITY DETERMINATION

An enrollee may appeal a determination that a medical item or service that is within the enrollee's scope of covered benefits is not medically necessary. In all such appeals, the burden of proof will rest with the enrollee at all stages.

Tenn. Comp. R. & Regs. 1200-13-16-.08

Public necessity rule filed December 1, 2006; expires May 15, 2007. Original rule filed March 1, 2007; effective May 15, 2007.

Authority: T.C.A. §§ 4-5-209, 71-5-105, 71-5-109, Executive Order No. 23.