In October of 2008, Benefits Administration implemented the Administrative Error and Benefits Administration Review Team, or BART, review process. Appeals submitted to Benefits Administration undergo a two-level process. Appeals that are denied on the first level via either an Administrative Error Form or Member Appeal, can be forwarded to BART if a member or agency requests further review.
BART is a group of three Benefits Administration professionals whose purpose is to meet to review and vote on appeals from employees who were denied at the first level. The scope of BART includes, but is not limited to, enrollment and eligibility, cancellation/termination, change requests, etc.
Benefit or health service issues (such as pre-determination requests, claim denials or claims payment matters) are handled through the respective insurance carriers. Those are called Medical Service Appeals and Benefits Administration does not govern nor has the access to any step of the appeal process through the insurance carriers.
BART consists of an odd number of voting members to avoid the possibility of a tie vote. Persons in a position of authority who may have made a final determination at initial levels or those who can override the team’s decision cannot sit on the review team. BART discusses each request and votes to either approve or deny the request and decisions are based on majority vote.
A request for further review by BART may be submitted by the employer/agency/ABC or directly by the member. Written requests must include the plan member’s name, employee ID (or Social Security number), phone number or email address, explanation of the issue, and reason why the additional review is being requested along with further supporting documentation relating to the request. The mailing address is:
312 Rosa L. Parks Avenue, Suite 1900, WRS Tennessee Tower, Nashville, TN 37243.
Upon receipt of the request, the appeals section reviews the issue and gathers information as needed. If the issue appears to be an administrative error, the appeals section will forward the paperwork to the operations unit for approval and corrective action absent a review by the BART. If the issue is determined not to be an administrative error, the appeals section will prepare the case so that items identifying the individual are blocked and schedule the issue for review by the BART. Cases are identified only by case number and situation in order to promote a fair and unbiased determination.
The time frame for their review process varies. However, most cases take approximately three weeks from date of receipt by the appeals section. Unless additional documentation is requested or depending on the volume of appeals the team must schedule at the time, the review could take longer.
Within three business days of the determination review by BART, the appeals section will prepare decision letters for mailing and communicate processing instructions to the Benefits Service Center.
Any exceptions granted by the Benefits Administration Review Team are individual to the case in question
should not be construed by anyone as a policy change on the part of the State Group Insurance
Program.
Inquiries regarding eligibility and enrollment issues should be directed to Benefits Administration – Appeals Section: (Phone) 615-532-2200 or 1-866-576-0029, (FAX) 615-253-8556.