4123-6-04.4 MCO Scope of services - fee bill review and audit process.

The MCO shall review all bills submitted to it for payment by a provider for appropriateness consistent with the MCO’s utilization standards and certification requirements. The MCO shall have in place and operating a grievance hearing procedure allowing a provider, employer, or employee to grieve a disputed bill payment.

R.C. 119.032 review dates: 10/27/2004 and 03/01/2009

Promulgated Under: 119.03

Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05

Rule Amplifies: 4121.121, 4121.44, 4121.441, 4123.66

Prior Effective Dates: 2/16/96