Section 418.101305. Resolution of disputes.

(1) If a carrier adjusts a fee or rejects a  bill under these rules, then a notice given pursuant to  R   418.101301   creates   a continuing dispute for the purpose of section 801 of the  act.  The   time for  making payment of a bill under section 801 of  the  act  shall  not run unless the bill is properly submitted according to applicable rules and statutes.

(2)   A magistrate, as provided under sections 315 and 847 of the act and R 408.34 and R 408.35, shall resolve any dispute that concerns any  of  the following:

(a)   The medical appropriateness of health care or a health care service.

(b)   Utilization of health care or a health care service.

(c)   The need for health care or a health care service.

(d)  Any dispute over the cost of health care or a health care service.

(3)   The agency may participate in any hearings that concern disputes when there is an issue that affects the provisions of these rules regarding maximum fees, medical appropriateness,  or  utilization  of health care or health care services.

History: 2000 AACS; 2005 AACS.