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Internal Appeal

Date of Publication

9/26/2011

Definition

An administrative review of program determinations regarding medical necessity that is internal to the medical treatment facility/dental treatment facility MTF/DTF (for direct care) or to the Managed Care Support Contractor (MCSC) (for purchased care). Progression through the successive levels of appeal occurs when the reviewing authority upholds the initial denial and the beneficiary, dissatisfied with the denial decision, files the next level of appeal.

Source of Definition

DoDI 6000.14: DoD Patient Bill of Rights and Responsibilities in the Military Health System

Last Updated: December 05, 2018

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