TRICARE Operations Manual 6010.59-M, April 1, 2015 Chapter 12 Appeals And Hearings Revision: Section/Addendum Subject/Addendum Title 1 General 2 Governing Principles 3 Reconsideration Procedures 4 Appeals Of Medical Necessity Determinations 5 Appeal Of Factual (Non-Medical Necessity) Determinations 6 Defense Health Agency (DHA) Appeals A Figures Figure 12.A-1 Appointment Of Representative And Authorization To Disclose Information Figure 12.A-2 Appeal Summary Log, TMA Form 607 Figure 12.A-3 Professional Qualifications, TMA Form 780 Figure 12.A-4 Letter To Proper Appealing Party When Review Has Been Requested By An Improper Appealing Party Figure 12.A-5 TRICARE Appeals Process - Medical Necessity Denials Figure 12.A-6 TRICARE Appeals Process - Factual Determinations Figure 12.A-7 TRICARE/Medicare Dual Eligible Appeal Process - Medicare Processes Claim Figure 12.A-8 Suggested Wording For Non-Expedited Written Appeal Notice (Including Factual Determinations) Figure 12.A-9 Suggested Wording For An Appeal Of A Preadmission/Preprocedure Initial Denial Determination Figure 12.A-10 Suggested Wording For A Concurrent Review Initial Denial Determination Figure 12.A-11 Suggested Wording For Inclusion In A Reconsideration Determination In Which A Provider Is A Network Provider Figure 12.A-12 Suggested Wording For A Non-Expedited Reconsideration Determination