8.0 Reprocessing Of Claims And
Preadmission/Preprocedure Requests Following Issuance Of Reconsideration
Determinations, Formal Review Determinations And Hearing Final Decisions
DHA
will provide the appropriate contractor with a copy of the formal
review determination and hearing final decision. All contractor
determinations reversed in whole or in part by the contractor’s
or the TRICARE Quality Management Contract (TQMC) contractor’s reconsideration determination,
the DHA formal review determination, or by a hearing final decision,
shall be reprocessed by the contractor in accordance with the standards
set forth in
Chapter 1, Section 3. For the purposes of
Chapter 1, Section 3, the date of receipt
is considered the date the TQMC contractor’s reconsideration determination,
the formal review determination, or the hearing final decision is received
by the contractor. The contractor must return to DHA any formal
review determinations or hearing final decisions misdirected to
the contractor.