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Michigan Administrative Code (Last Updated: November 16, 2016) |
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Department LR. Licensing and Regulatory Affairs |
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Workers Compensation Agency |
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Chapter Workers' Compensation Health Care Services Rules |
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Part 12. Carrier's professional health care review program R 418.101201 Carrier's health care review program. |
Section 418.101207. Types of certification.
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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.
History: 2000 AACS; 2005 AACS; 2012 AACS.