405 Ind. Admin. Code 11-4-1

Current through October 31, 2024

Section 405 IAC 11-4-1 - Provider appeal procedures

Authority: IC 12-17.6-2-11

Affected: IC 12-17.6

Sec. 1.

(a) All provider appeals from office action taken under this article shall be governed by the procedures and time limits for Medicaid providers set out in 405 IAC 1-1.5.

(b) Providers who have contracts with CHIP risk-based MCOs right to appeal actions taken by the MCO is limited to that provided for in their contracts with the MCO. There is no state appeal right.

(c) The reimbursement dispute resolution procedure set out in 405 IAC 1-1.6 shall apply to providers who do not have a contract with a CHIP risk-based MCO for services provided under CHIP.

405 IAC 11-4-1

Office of the Secretary of Family and Social Services; 405 IAC 11-4-1; filed May 3, 2000, 2:02 p.m.: 23 IR 2230; readopted filed May 22, 2006, 3:22 p.m.: 29 IR 3424; filed Jun 1, 2011, 2:28 p.m.: 20110629-IR-407100420FRA; readopted filed Jun 18, 2012, 11:23 a.m.: 20120718-IR-407120202RFA; readopted filed 4/9/2018, 9:12 a.m.: 20180509-IR-405180110RFA

Transferred from the Office of the Children's Health Insurance Program ( 407 IAC 1-4-1) to the Office of the Secretary of Family and Social Services ( 405 IAC 11-4-1) by P.L. 35-2016, SECTION 53, effective March 21, 2016.