You can file a medical necessity appealThe action you take if you don’t agree with a decision made about your benefit. if we deny prior authorization for care or services because we feel it isn’t medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition..
Medical necessity appeals can be either expedited or non-expedited.
The contractor sends you an appeal decision. If you disagree with the decision, you can request a reconsideration from the TRICARE Quality Monitoring Contractor.
Send a letter to the TRICARE Quality Monitoring Contractor. Make sure the postmark is within 90 days of the date on the appeal decision.
The TRICARE Quality Monitoring Contractor reviews the case and issues a reconsideration decision.
The independent hearing takes place at location convenient to both the requesting party and the government.
Last Updated 12/1/2016
Defense Health Agency
Appeals, Hearings and Claims Collection Division
16401 E. Centretech Parkway
Aurora, CO 80011-9066
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