Medical Provider

Time Limits

• Authorization Rule 16-9

  Authorization Rule 16-10

  • 7 days to respond to request Rule 16-10(A), (B)

   

• Payment of Medical Bills Rule 16-11

  • 120 days Bill for services rendered Rule 16-11(A)(1)

  • 30 days Payment or denial due Rule 16-11(A)(2)

  • 30 days payer’s written contest of payment Rule 16-11(A)(2)

  • 60 days for provider to respond to payment or contest
    Rule 16-11(D)(1)

  • 30 days for payer to respond to provider’s response
    Rule 16-11(D)(1)

• Review of Facilities Rule 16-12

  • 30 days of receipt of bill Rule 16-12(B)

  • 30 days from request allow review to begin Rule 16-12(C)(1)

  • 10 days to respond to all review findings Rule 16-12(C)(4)

  • 20 days reviewer must provide summary Rule 16-12(D)(5)

• WC 164 due to payer within 14 days of service Rule 16-7(E)(3)

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