Chapter 61 - TENNESSEE HEALTH CARRIER GRIEVANCE AND EXTERNAL REVIEW PROCEDURE ACT
- 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