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The Office of Medical Services 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 regulatory language for resolution of reimbursement disputes in Section 440.13(7):
(a) Any health care provider, carrier, or employer who elects to contest the disallowance or adjustment of payment by a carrier …must, within 30 days after receipt of notice of disallowance or adjustment of payment, petition the department to resolve the dispute. The petitioner must serve a copy of the petition on the carrier and on all affected parties by certified mail. The petition must be accompanied by all documents and records that support the allegation s contained in the petition. Failure of a petitioner to submit such documentation to the department results in dismissal of the petition.
The Department adopted 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 Office of Medical Services 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 Office of Medical Services.
Rule 69L-31.004, F.A.C. incorporates the
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.