DISPUTED REIMBURSEMENT, Service of Petition on Carrier and Affected Parties, Carrier Response Requirements, Effect of Non-Response by Carrier

DEPARTMENT OF FINANCIAL SERVICES
Residual Markets and Special Risk Pools

RULE NO: RULE TITLE
59A-31: DISPUTED REIMBURSEMENT
59A-31.007: Service of Petition on Carrier and Affected Parties
59A-31.009: Carrier Response Requirements
59A-31.010: Effect of Non-Response by Carrier

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 32 No. 29, July 21, 2006 issue of the Florida Administrative Weekly.

59A-31.007 Service of Petition on Carrier and Affected Parties.

(1) No change.

(2) Carrier designation of an entity to receive service on behalf of the carrier and all affected parties, as required by paragraph 69L-7.602(5)(q), F.A.C., does not confer standing on the designated entity beyond that which the entity would otherwise have under applicable law.

(2) through (4) renumbered (3) through (5) No change.

59A-31.009 Carrier Response Requirements.

(1) The Carrier Response to Petition for Resolution of Reimbursement Dispute Form, accompanied by all requested information, must be served upon the Agency within ten calendar (10) days after receipt of a copy of the petition by United States Postal Service (USPS) certified mail. However, where the carrier has received curative documentation from the petitioner pursuant to subsection 59A-31.005(2), F.A.C., the Carrier Response to Petition for Resolution of Reimbursement Dispute Form, accompanied by all requested information, must be served upon the Agency within ten (10) calendar days after receipt, by the carrier of the curative documentation from the petitioner. The carrier’s response to the petition must include a completed Carrier Response to Petition for Resolution of Reimbursement Dispute Form (AHCA Form 3160-0024, effective September 8, 2006). Failure of the carrier to meet these requirements constitutes waiver of all objections to the petition.

(2) through (3) No change.

59A-31.010 Effect of Non-Response by Carrier.

(1) Failure of the carrier to timely submit a Carrier Response to Petition for Resolution of Reimbursement Dispute Form (AHCA Form 3160-0024, effective September 8, 2006) and accompanying documentation substantiating its disallowance or adjustment of payment constitutes a waiver of all objections to the petition. Waiver of all objections to the petition shall result in the Agency determination and final order being based solely upon the allegations and supporting documentation submitted by the petitioner.

(2) If a carrier has waived all objections to the petition under Section 440.13(7), F.S., with regard to a particular disallowance, adjustment or denial of payment, the carrier has also waived relief under Section 440.13(8), F.S., or Section 44013(11), F.S. with regard to the payment(s) that was in dispute in the petition under Section 440.13(7), F.S.