1(1) The Department will render a written determination on whether the Carrier properly adjusted or disallowed payment pursuant to Section 21440.13(7)(c), F.S., 23by relying on the Petition Form, Response Form, and all supporting documentation submitted to the Department by the Petitioner and the Carrier to support their respective positions. The Department will use an Expert Medical Advisor (EMA), in accordance with Section 63440.13(9)(b), F.S., 65to assist in resolving Reimbursement Disputes associated with the disallowance or adjustment of payment based upon Medical Necessity of the services in the Notice of Disallowance or Adjustment when both the Petitioner (pursuant to paragraph 10069L-31.003(3)(e), 101F.A.C.) and Carrier (pursuant to paragraph 10769L-31.004(3)(b), 108F.A.C.) have provided documentation to support their respective decisions on the Medical Necessity of the services. If an EMA is utilized by the Department, all forms and documentation received pursuant to Rules 14069L-31.003141and 14269L-31.004, 143F.A.C., will be forwarded to the EMA.
150(2) In its written determination, the Department will address the specific line item(s) in the Notice of Disallowance or Adjustment that the Petitioner contends were improperly disallowed or adjusted.
