NDAC 75-03-15-16
Review and appeals
Cite as N.D. Admin. Code ยง 75-03-15-16
1.
Review.
a.
A facility may request a review of denial of payment by filing a written request for review
with the department within thirty days of the date of the department's denial of payment.
The written request for review must include the notice and a statement of each disputed
item with the reason or basis for the dispute. A facility may not request review for a full or
partial denial, recoupment, or adjustment of a claim due to required federal or state
changes, payment system defects, or improper claims submission or of the rate paid for
a particular service or difficulty of care rate.
b.
Within thirty days after requesting a review, a facility shall provide to the department all
documents, written statements, exhibits, and other written information that support the
facility's request for review, together with a computation and the dollar amount that
reflects the facility's claim as to the correct computation and dollar amount for each
disputed item.
c.
The department shall make and issue a decision within seventy-five days, or as soon
thereafter as possible, of receipt of notice of request for review.
2.
Appeals. A facility may appeal the final decision of the department to the district court in the
manner provided in North Dakota Century Code section 28-32-42, and the district court shall
review the department's final decision in the manner provided in North Dakota Century Code
section 28-32-46. The judgment of the district court in an appeal from a request for review
may be reviewed in the supreme court on appeal by any party in the same manner as
provided in North Dakota Century Code section 28-32-49.
3.
Upon receipt of notice that the facility has appealed its final decision to the district court, the
department shall make a record of all documents, written statements, exhibits, and other
written information submitted by the facility or the department in connection with the request
for review and the department's final decision on review, which constitutes the entire record.
Within thirty days after an appeal has been taken to district court as provided in this section,
the department shall prepare and file in the office of the clerk of the district court in which the
appeal is pending the original and a certified copy of the entire record, and that record must
be treated as the record on appeal for purposes of North Dakota Century Code section
28-32-44.