W. Va. Code R. § 85-28-5

Current through Register Vol. XLI, No. 40, October 4, 2024
Section 85-28-5 - Final decision; Petition for Hearing
5.1. Notice of final decision. The Commission shall notify each health care vendor of its final decision by United States mail, first class, postage pre-paid.
5.1.a. The notice of final decision shall include language to inform the health care provider that it is afforded the right to file a petition for hearing of the decision and provide an address where the request for reconsideration shall be filed.
5.2. Time limits. A petition for hearing shall be filed with the Commission within thirty (30) days of the health care provider's receipt of notice of the disputed decision or action or, in the absence of such a receipt, within sixty (60) days of the date of the Commission's making such disputed decision or taking such disputed action. Such time limitations are a condition of the right to litigate the decision or action and are jurisdictional.
5.3. Contents of the petition for hearing. In its petition for hearing, the health care provider shall:
(1) clearly identify the decision or action disputed;
(2) clearly identify the bases upon which the health care provider disputes the decision or action; and
(3) provide a summary of documentation supporting the health care provider's position.
5.4. Collection of an alleged overpayment shall remain in abeyance until such time as the matter becomes final under these provisions.

W. Va. Code R. § 85-28-5