Mich. Admin. Code R. 418.101205

Current through Vol. 24-19, November 1, 2024
Section R. 418.101205 - Scope of professional health care review

Rule 1205.

(1) The carrier, or it's review company, shall review case records and health-service bills, or both, under the professional health care review program as follows:
(a) A case where health care service payments, excluding inpatient hospital care, exceed $20,000.00.
(b) A case involving inpatient hospital care.
(2) The carrier or other entity may at any time review any case record or bill which the carrier or the other entity believes may involve inappropriate, insufficient, or excessive care.

Mich. Admin. Code R. 418.101205

2000 AACS; 2005 AACS