Military Health System

1.2.1  When DHA receives a request for a formal review or hearing, the contractor and the TQMC contractor will be requested to furnish the complete file(s) covering the claim(s) and reconsideration(s) in dispute. (See Section 3, paragraph 4.5 for requirements.) The DHA Office of General Counsel (OGC) will request the entire appeal file by telephone, facsimile transmission (fax). The contractor will also provide copies of nonproprietary information extracted from its agreements with network providers and non-network institutional providers involved in the formal review or hearing case if requested to do so by the DHA OGC. The contractor shall copy the entire file (making one-sided copies only) and mail it by express mail to the DHA OGC, as soon as possible.

1.2.2  In no case shall the sending of the file occur later than five workdays after receipt of the request. In addition, upon request, the contractor shall assist DHA in developing additional information as may be necessary to fully develop facts in the case. To facilitate communications between DHA, the TQMC contractor, and the contractor, the names of specific persons in the centralized appeal unit who are responsible for coordination of appeal functions shall be furnished to the DHA OGC Point Of Contact (POC) and the TQMC contractor by the contractor. Names and phone numbers shall be updated as necessary and notice provided.