The file's text, extracted by GovTribe without its formatting.
Appeals
| State: | | Internal Appeals | | | External Appeals | | |
| Product: | | 2009 | 2010 | 2011 | 2009 | 2010 | 2011 |
| Number of total appeals upheld | | | | | | |
| Basis for original denial: | | | | | | |
| Medical necessity | | | | | | |
| Experimental or investigational | | | | | | |
| Incorrect claim adjudication or administrative error | | | | | | |
| Contractual denial | | | | | | |
| Number of total appeals overturned |
| Basis for original denial: |
| Medical necessity |
| Experimental or investigational |
| Incorrect claim adjudication or administrative error |
| Contractual denial |
| Number of total appeals partially overturned |
| Basis for original denial: |
| Medical necessity |
| Experimental or investigational |
| Incorrect claim adjudication or administrative error |
| Contractual denial |
| Number of total appeals administratively reversed |
| Basis for original denial: |
| Medical necessity |
| Experimental or investigational |
| Incorrect claim adjudication or administrative error |
| Contractual denial |
| Number of total appeals withdrawn |
| Basis for original denial: |
| Medical necessity |
| Experimental or investigational |
| Incorrect claim adjudication or administrative error |
| Contractual denial |
| Number of total appeals dismissed |
| Basis for original denial: |
| Medical necessity |
| Experimental or investigational |
| Incorrect claim adjudication or administrative error |
| Contractual denial |
| 2009 | 2010 | 2011 |
| Percent of claims denied (denied claims/total claims filed) | | | |
| Percent of denied claims that were appealed (appeals/total number of denied claims) | | | |
| Percent of claims appealed (appeals/total number of claims filed) | | | |
| * Outcome based on the last level filed by the consumer | | | |
&"+,Bold"&13&K04+000Appendix A: Appeals
&"+,Regular"&K04+000D R A F T MSPP Application September 2012 &P
