Mich. Admin. Code R. 500.65 - Appeals to the department

Rule 65.

(1) A provider may appeal a determination made by an insurer or the association. The appeal must be filed within 90 days of the date of the disputed determination and must be made on a form prescribed by the department.

(2) Within 14 days of receipt of a provider appeal, the department shall notify the insurer or the association and the injured person of the appeal and request any additional information necessary to review the appeal.

(3) An insurer or the association may file a reply to a providers appeal no later than 21 days after the date of the notice provided under subrule (2) of this rule.

(4) The director shall base his or her decision upon written materials submitted by the parties. Failure of any party to supply any information in a timely manner shall result in a decision based upon information available to the director at the time of the decision.

(5) The director shall issue a decision within 28 days after the insurer or the association files a reply to a providers appeal or, if a reply is not filed, within 28 days after the time for filing a reply has expired. The director may, upon written notice to the insurer or the association and the provider, take an additional 28 days to issue a decision under this rule.

(6) If a provider appeals a determination made by an insurer and the department issues a decision that the provider is entitled to payment, the provider is entitled to interest on any overdue payments as set forth in section 3142 of the act, MCL 500.3142.

(7) A decision issued by the department under these rules is subject to judicial review as provided in section 244(1) of the act, MCL 500.244(1).

Notes

Mich. Admin. Code R. 500.65

2020 MR 24, Eff. 12/18/2020