Mich. Admin. Code R. 418.101207 - Types of certification
Rule 1207.
(1)
Certification shall be either unconditional or conditional.
(2) The workers' compensation agency shall
issue unconditional certification for a period of 3 years.
(3) The agency may issue conditional
certification if it is determined that the carrier or other entity does not
fully satisfy the criteria in
R 418.101206(3).
If the carrier or other entity agrees to undertake corrective action, then
conditional certification shall be granted by the agency for a maximum period
of 1 year.
(a) If the workers' compensation
agency receives multiple written complaints regarding a carrier, or the
carrier's review process, and the agency determines the complaints are valid,
or that the carrier has not processed payment for medical services in accord
with these rules, then the agency may issue conditional
certification.
(4) The
workers' compensation agency may at any time modify an unconditional
certification to a conditional certification if the agency determines that the
carrier or other entity fails to satisfy the criteria set forth in
R
418.101206(3).
(5) The carrier shall have the right to
appeal the certification decisions under the procedures in these
rules.
(6) Failure to file Annual
Report (WC406) or Professional Certification for Health Care Review Program
(WC590) may result in denial or downgrading of the certification of a Health
Care Review Program by the workers' compensation agency.
Notes
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