Reimbursement Disputes are handled by the Division's Medical Services Section located within the Bureau of Monitoring & Audit. Subsection 440.13(7), Florida Statutes and Chapter 69L-31, Florida Administrative Code, outline the reimbursement dispute resolution process. Listed below are high level bullets for parties of a reimbursement dispute and several links to participate or learn more about this process.
Health care providers electing to contest the disallowance or adjustment of payment by a carrier:
- Must petition the Division to resolve the dispute within 45 days after receipt of notice of disallowance or adjustment of payment.
- 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 allegations contained in the petition. Failure of a petitioner to submit such documentation to the department may result in dismissal of the petition.
Carriers responding to reimbursement dispute petitions:
- Must submit to the Division within 30 days after receipt of the petition all documentation substantiating the carrier's disallowance or adjustment of payment.
- Failure of the carrier to timely submit such documentation to the Division within 30 days constitutes a waiver of all objections.
Section 440.13, F.S., Medical services and supplies; penalty for violations; limitations.
Chapter 69L-31, F.A.C., Utilization and Reimbursement Dispute Rule