Michigan Administrative Code
Department - Labor and Economic Opportunity
Workers Compensation Agency
Workers' Compensation Health Care Services Rules
Part 12 - CARRIER'S PROFESSIONAL HEALTH CARE REVIEW PROGRAM
Section R. 418.101205 - Scope of professional health care review

Universal Citation: MI Admin Code R. 418.101205

Current through Vol. 24-16, September 15, 2024

Rule 1205.

(1) The carrier, or it's review company, shall review case records and health-service bills, or both, under the professional health care review program as follows:

(a) A case where health care service payments, excluding inpatient hospital care, exceed $20,000.00.

(b) A case involving inpatient hospital care.

(2) The carrier or other entity may at any time review any case record or bill which the carrier or the other entity believes may involve inappropriate, insufficient, or excessive care.

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