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. 418.101206 - Certification of professional health care review program

Universal Citation: MI Admin Code R. 418.101206

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

Rule 1206.

(1) The agency shall certify the carrier's professional health care review program.

(2) A carrier, or the reviewing entity on behalf of the carrier, shall apply to the agency for certification of a carrier's professional health care review program in the manner prescribed by the agency.

(3) A carrier shall receive certification if the carrier or the carrier's review company provides to the agency a description of its professional health care review program and includes all of the information specified in R 418.101204. The agency shall send a copy of the certification of the carrier's review program to the carrier.

(4) The carrier shall submit to the agency for approval a copy of "The Carriers Explanation of Benefits" form utilized to notify providers of payment decisions.

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