Committee Review Of Fee Schedule Disputes/Hearings

(1) Medical Payment Committee (the Committee) Review Procedure: (a) When a valid request for Committee Review is received by the Bureau’s Medical Director, the parties will be notified at least seven (7) business days in advance when the Committee will consider the dispute. The Committee may consider the dispute at any meeting during which it has a quorum of the voting members. Members may participate by telephone or by video conferencing or by properly executed proxy. Members that participate by telephone or video conferencing or properly executed proxy shall be counted as present for purposes of establishing a quorum. (b) The parties will have the opportunity to submit documentary evidence and present arguments to the Committee prior to and during the Committee meeting in which the dispute will be heard. Written submissions to the committee shall be received by the Bureau at least one week in advance of the meeting. A redacted copy of all written material shall be included with any submission. (c) The Committee shall consider the dispute and issue its decision on the merits as to the proper resolution of the dispute, based upon a simple majority vote of the members present for the purpose of a quorum. If the dispute cannot be decided in one meeting, then the Committee may continue it to the next meeting. RULES FOR MEDICAL PAYMENTS CHAPTER 0800-02-17 (d) If the parties to the dispute do not follow the decision of the Committee, then either party may proceed in any court of law with proper jurisdiction to decide the dispute. (2) Computation of Time Periods: In computing a period of time prescribed or allowed by the Rules, the day of the act, event or default from which the designated period of time begins to run shall not be included. The last day on which compliance therewith is required shall be included. If the last day within which an act shall be performed or an appeal filed is a Saturday, Sunday, or a legal holiday, the day shall be excluded, and the period shall run until the end of the next day which is not a Saturday, Sunday, or legal holiday. “Legal holiday” means those days designated as a Tennessee State holiday. (3) Member Responsibilities: Each member is required to complete the current state designated Conflict of Interest form (COI) each fiscal year.