Mich. Admin. Code R. 418.101303 - Provider's request for reconsideration of bill; carrier's response to provider's right to appeal
Rule 1303.
(1)
Within 30 days of receipt of a provider's request for reconsideration, the
carrier shall notify the provider of the actions taken and provide a detailed
statement of the reasons. The carrier's notification shall include an
explanation of the appeal process provided under these rules, including the
fact that any requested administrative appeal hearing shall be conducted by a
director's representative, a magistrate, or both.
(2) If a provider disagrees with the action
taken by the carrier on the provider's request for reconsideration, then a
provider may file an application for mediation or hearing with the agency. A
provider shall send its application for mediation or hearing to the agency
within 30 days from the date of receipt of a carrier's denial of the provider's
request for reconsideration. The provider shall send a copy of the application
to the carrier.
(3) If, within 60
days of the provider's request for reconsideration, the provider does not
receive payment for the adjusted or rejected bill or a portion of the bill, or
a written detailed statement of the reasons for the actions taken by the
carrier, then the provider may apply for mediation or hearing. The provider
shall send the application for mediation or hearing to the agency and shall
send a copy to the carrier.
Notes
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