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(a) A provider may request review of a Medicaid claim under this section if
(1) the provider's initial claim was denied;
(2) the initial payment of the claim to the provider was reduced; or
(3) payment of the claim has been reduced by a recoupment action initiated by the division.
(b) A provider requesting review of a claim described in (a) of this section shall, no later than 60 days after the date of the remittance advice, submit to the division's designee
(1) a written request for a review of the claim, including any supporting documentation;
(2) a hard copy of the original claim that was denied or reduced and attachments;
(3) a copy of the remittance advice relating to the claim; and
(4) if an adjustment/void request form may be submitted to correct the claim, an adjustment/void request form completed by the provider that corrects information that was submitted with the original claim.
(c) The division or its designee may not consider a request for review submitted by a provider under (b) of this section if the provider does not provide the request for review and all information required by (b) of this section within the time allowed under (b) of this section for submission of the request and documents.
(d) At the conclusion of the review of a claim by the division's designee under (b) of this section, the division's designee shall make a determination on the claim.
(e) A provider that is not satisfied with the determination made on the provider's claim in a review under this section may file an appeal of the determination under 7 AAC 43.085(b) .
(f) The provisions of this section do not apply to actions taken under 7 AAC 43.950 - 7 AAC 43.985.
History: Eff. 11/29/97, Register 144
Authority: AS 47.05.010
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Last modified 7/05/2006