Fla. Admin. Code Ann. R. 69L-31.008 - Computation of Time
(1)
(a) The forty-five (45) day time period
within which a Petition Form must be submitted to the Department begins upon
receipt of the Notice of Disallowance or Adjustment by the Health Care Provider
or by an entity designated by the Health Care Provider to receive such notice
on behalf of the Health Care Provider.
(b) The Health Care Provider must document
receipt of the Notice of Disallowance or Adjustment by either:
1) using a date stamp that clearly reflects
the date of receipt of the Notice of Disallowance or Adjustment by the Health
Care Provider; or
2) using a
verifiable login process. A date-stamped Notice of Disallowance or Adjustment
will be accepted as proof of the date of receipt. A copy of the applicable
portion of the login roster showing the date of login of the Notice of
Disallowance or Adjustment will be accepted as proof of the date of receipt
through a verifiable login process.
(c) If receipt cannot be established through
a date stamp or verifiable login process, the Petitioner may provide a copy of
the envelope in which the Notice of Disallowance or Adjustment was sent that
clearly and legibly shows the postmark date, in which case receipt will be
deemed to be five (5) calendar days after the postmark date.
(d) If the Petitioner does not establish the
date of its receipt of the Notice of Disallowance or Adjustment by any of the
methods set forth in this subsection through documentation accompanying the
Petition Form, the Health Care Provider's receipt of the Notice of Disallowance
or Adjustment will be deemed to be five (5) calendar days after the issue date
on the Notice of Disallowance or Adjustment. An affidavit attesting to the date
of receipt will not be accepted as proof of the date of
receipt.
(2) Petitioning
the Department to resolve a Reimbursement Dispute is effectuated upon
submission of the Petition Form and supporting documentation to the Department.
The timeliness of a Petition Form will be calculated based on the date of
submission of the Petition Form to the Department in accordance with subsection
(4), below.
(3) The thirty (30) day
time period within which a Response Form must be submitted to the Department
begins upon the date the Carrier receives the Petition Form, which will be
established by the USPS certified mail receipt date. If the Department issues a
notice of deficiency to the Petitioner, then the thirty (30) day time period
within which a Response Form must be submitted to the Department begins upon
the date the Carrier receives the curative documentation, which will be
established by the USPS certified mail receipt date. Timely submission by the
Carrier to the Department of the Response Form and supporting documentation
will be determined based on the date of submission of the Response Form and
supporting documentation to the Department in accordance with subsection (4),
below.
(4) Submission of a Petition
Form or Response Form to the Department must be by USPS mail, by common
carrier, or by hand delivery. If submission is by USPS mail, the date of
submission to the Department will be the postmark date placed on the envelope
by USPS. If submission is by common carrier, the date of submission to the
Department will be the common carrier pick-up date. If submission is by hand
delivery, the date of submission will be the date the Petition Form or Response
Form is hand delivered to the receptionist at the hand delivery address listed
on the forms (which can only be accomplished Monday through Friday, between
8:00 a.m. and 5:00 p.m., Eastern Time, excluding state of Florida
holidays).
(5) Time periods
established for petitioning the Department to resolve a Reimbursement Dispute
or responding to a Petition Form are not tolled by any of the following
actions: requesting an on-site audit; conducting an on-site audit; referral of
the Health Care Provider for peer review consultation; or an independent
medical examination of the injured employee.
Notes
Rulemaking Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7), (11) FS.
New 11-28-06, Formerly 59A-31.008, Amended 8-2-21.
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