The TR3, p.33 states: The requester can specify a UM02 value of N (Reconsideration) to request the UMO to reconsider a previously denied referral or certification request. Normally, a request for reconsideration precedes an appeal.
Can clarification be provided on the last statement regarding "Normally"? This seems to imply that it is NOT always the first step for an appeal. In some cases, would a denied response result in the next Request being an Appeal? If that is the case, are there rules defining when Reconsideration is used instead of Appeal - Immediate or Appeal -Standard?
Can Reconsideration only be used if HCR01 in the response is returned with A3 (Not Certified). I'm trying to determine if it can also be used with an HCR01 value of A6 (Modified) when the request is an Appeal.
"Reconsideration” is nothing more than a process that can be utilized before an official appeal process. What is considered an “Appeal” versus “Reconsideration” would be defined by the individual UMO to include which HCR01 values returned in the response that would be considered for the appeal process.