Mich. Admin. Code R. 418.101206 - Certification of professional health care review program
Rule 1206.
(1) The
agency shall certify the carrier's professional health care review
program.
(2) A carrier, or the
reviewing entity on behalf of the carrier, shall apply to the agency for
certification of a carrier's professional health care review program in the
manner prescribed by the agency.
(3) A carrier shall receive certification if
the carrier or the carrier's review company provides to the agency a
description of its professional health care review program and includes all of
the information specified in
R 418.101204. The agency shall
send a copy of the certification of the carrier's review program to the
carrier.
(4) The carrier shall
submit to the agency for approval a copy of "The Carriers Explanation of
Benefits" form utilized to notify providers of payment decisions.
Notes
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