Section 75-03-15-16 - Review and appeals1.Review.a. A facility may request a review of denial of payment by filing a written request for review with the department within thirty days of the date of the department's denial of payment. The written request for review must include the notice and a statement of each disputed item with the reason or basis for the dispute. A facility may not request review for a full or partial denial, recoupment, or adjustment of a claim due to required federal or state changes, payment system defects, or improper claims submission or of the rate paid for a particular service or difficulty of care rate.b. Within thirty days after requesting a review, a facility shall provide to the department all documents, written statements, exhibits, and other written information that support the facility's request for review, together with a computation and the dollar amount that reflects the facility's claim as to the correct computation and dollar amount for each disputed item.c. The department shall make and issue a decision within seventy-five days, or as soon thereafter as possible, of receipt of notice of request for review.2.Appeals. A facility may appeal the final decision of the department to the district court in the manner provided in North Dakota Century Code section 28-32-42, and the district court shall review the department's final decision in the manner provided in North Dakota Century Code section 28-32-46. The judgment of the district court in an appeal from a request for review may be reviewed in the supreme court on appeal by any party in the same manner as provided in North Dakota Century Code section 28-32-49.3. Upon receipt of notice that the facility has appealed its final decision to the district court, the department shall make a record of all documents, written statements, exhibits, and other written information submitted by the facility or the department in connection with the request for review and the department's final decision on review, which constitutes the entire record. Within thirty days after an appeal has been taken to district court as provided in this section, the department shall prepare and file in the office of the clerk of the district court in which the appeal is pending the original and a certified copy of the entire record, and that record must be treated as the record on appeal for purposes of North Dakota Century Code section 28-32-44.N.D. Admin Code 75-03-15-16
Amended by Administrative Rules Supplement 2021-382, October 2021, effective 10/1/2021.General Authority: NDCC 50-06-16, 50-11-03
Law Implemented: NDCC 50-06-05.1, 50-11-03.2