Administrative Review of Appeal
The initial review of any appeal will be an administrative review done by the Trust Office in conjunction with the assistance of the Trust's medical review organization or other appropriate provider. The Trust Office will notify you of its decision within 30 days of receipt of your appeal. The administrative review decision shall:
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State the specific reason for the denial;
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Reference the plan provision(s) relied on;
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Describe any additional information necessary to perfect your claim and the reason it is necessary;
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Explain the Trust's claims procedures; and
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Describe what information is available to you.
The Trust Office's administrative review will be final and binding unless you submit a written request for review within 60 days of the denial. Upon receipt of a request for review the Trust Office may refer the matter to the Administrative Committee at its next meeting for informal consultation and comment. If this consultation does not resolve the appeal, the matter will be referred to the Claims Appeal Panel for formal review.
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