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The Medical Services Section is statutorily responsible for the resolution of reimbursement disputes arising from reimbursement paid for services rendered to Florida’s injured workers. The Florida Statutes provide the updated regulatory language effective July 1, 2013, for resolution of reimbursement disputes in Section 440.13(7):
The Department adopted and is currently updating Rule Chapter 69L-31, Florida Administrative Code, to clarify the reimbursement dispute resolution process, the time frames and documentation that are required for a petition to be valid. Rule 69L-31.003, F.A.C. incorporates the Petition for Resolution of Reimbursement Dispute Form (DFS Form 3160-0023 ) (Petition), which must be submitted to the Medical Services Section when seeking resolution of a reimbursement dispute. All items on the petition form must be completed for the Petition to be valid and accepted by the Medical Services Section.
Rule 69L-31.004, F.A.C. incorporates the Carrier Response to Carrier Response to Petition for Resolution of Reimbursement Dispute
Form (DFS Form 3160-0024 ) (Carrier Response), which is the only form accepted by the department upon which a carrier may submit its response to a Petition for Resolution of Reimbursement Dispute (Petition). Failure to submit a Carrier Response form results in the Carrier waiving all objections to the allegations in the Petition.