405 IAC 10-9-2 Provider grievances and appeals; managed care organizations

Sec. 2. (a) The right of providers contracting with managed care organizations to dispute any actions taken by the managed care organization shall be governed by the provider's contract with the managed care organization. (b) The reimbursement dispute resolution procedure set forth at 405 IAC 1-1.6 shall apply to providers who do not have a contract with a managed care organization for services provided under the plan. (c) Any provider disputes involving prior authorization determinations made by the managed care organizations shall be governed by the managed care organization's procedures for provider grievances and appeals. (d) A contracted or noncontracted provider shall have no right to appeal a managed care organization's action to the state.