Mich. Admin. Code R. 418.101205 - Scope of professional health care review
Rule 1205.
(1) The
carrier, or it's review company, shall review case records and health-service
bills, or both, under the professional health care review program as follows:
(a) A case where health care service
payments, excluding inpatient hospital care, exceed $20,000.00.
(b) A case involving inpatient hospital
care.
(2) The carrier or
other entity may at any time review any case record or bill which the carrier
or the other entity believes may involve inappropriate, insufficient, or
excessive care.
Notes
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