(a)  A provider may request a reconsideration review within 30 calendar days from receipt of final notification of payment, payment denial, disallowances, payment adjustment, notice of program reimbursement and adjustments and within 60 calendar days from receipt of notice of an institutional reimbursement rate.  Final notification of payment, payment denial, disallowances and payment adjustment means that all administrative actions necessary to have a claim paid correctly have been taken by the provider and DMA or the fiscal agent has issued a final adjudication.  If no request is received within the respective 30 or 60 day periods, the state agency's action shall become final.

(b)  A request for reconsideration review must be in writing and signed by the provider and contain the provider's name, address and telephone number.  It must state the specific dissatisfaction with DMA's action and should be mailed to:  Appeals, Division of Medical Assistance at the Division's current address.

(c)  The provider may appoint another individual to represent him.  A written statement setting forth the name, address and telephone number of the representative so designated shall be sent to the above address.  The representative may exercise any and all rights given the provider in the review process.  Notice of meeting dates, requests for information, hearing decisions, etc. will be sent to the authorized representative.  Copies of such documents will be sent to the petitioner only if a written request is made.


History Note:        Authority G.S. 108A‑25(b); 108A‑54; 150B‑11; 42 U.S.C. 1396(b);

Eff. January 1, 1988.