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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-35A (LB-1023)
for the current year.
Form C-35A (LB-1023) Notice of Appeal Rights for a Utilization Review Denial - Tennessee
What Is Form C-35A (LB-1023)?
This is a legal form that was released by the Tennessee Department of Labor and Workforce Development - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-35A?
A: Form C-35A is a notice of appeal rights for a utilization review denial in Tennessee.
Q: What does Form C-35A entail?
A: Form C-35A informs individuals of their rights to appeal a utilization review denial in Tennessee.
Q: Who is this form for?
A: This form is for individuals who have received a utilization review denial in Tennessee.
Q: What is a utilization review denial?
A: A utilization review denial is when a request for medical treatment is denied based on a review of its medical necessity.
Q: Why would I need to appeal a utilization review denial?
A: You may need to appeal a utilization review denial if you believe that the denial was incorrect or unfair.
Q: How can I use this form?
A: You can use Form C-35A to initiate the appeals process for a utilization review denial in Tennessee.
Form Details:
- Released on October 1, 2019;
- The latest edition provided by the Tennessee Department of Labor and Workforce Development;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form C-35A (LB-1023) by clicking the link below or browse more documents and templates provided by the Tennessee Department of Labor and Workforce Development.
Download Form C-35A (LB-1023) Notice of Appeal Rights for a Utilization Review Denial - Tennessee
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