Mich. Admin. Code R. 500.63 - Requests for explanation

Rule 63.

(1) If a provider provides treatment, training, products, services, or accommodations to an injured person that are not usually associated with, are longer in duration than, are more frequent than, or extend over a greater number of days than the treatment, training, products, services, or accommodations usually required for the diagnosis or condition for which the injured person is being treated, the insurer or the association may request that the provider explain the necessity or indication for the treatment, training, products, services, or accommodations in writing. An insurer or the association may request that the provider include in its written explanation medical records, bills, and other information concerning the treatment, training, products, services, or accommodations.

(2) If an insurer or the association requests a provider to provide a written explanation under this rule, the request must be submitted to the provider within 30 days of the insurers or associations receipt of the bill related to the treatment, training, products, services, or accommodations.

(3) A provider that receives a request for a written explanation from an insurer or the association must respond within 30 days of receipt of the insurers or associations request.

(4) If an insurers or the associations request for records under subrule (1) of this rule requires the provider to provide medical records, bills, or other information in excess of that which customarily accompany a bill submitted to the insurer or the association, the insurer or the association must reimburse the provider at a reasonable and customary fee, plus the actual costs of copying and mailing, within 30 days of the insurers or associations request.

Notes

Mich. Admin. Code R. 500.63

2020 MR 24, Eff. 12/18/2020