405 IAC 11-4-1 Provider appeal procedures

Sec. 1. (a) All provider appeals from office action taken under this article shall be governed by the procedures and time limits for Medicaid providers set out in 405 IAC 1-1.5. (b) Providers who have contracts with CHIP risk-based MCOs right to appeal actions taken by the MCO is limited to that provided for in their contracts with the MCO. There is no state appeal right. (c) The reimbursement dispute resolution procedure set out in 405 IAC 1-1.6 shall apply to providers who do not have a contract with a CHIP risk-based MCO for services provided under CHIP.