R 418.101206 Certification of professional health care review program.

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.