Florida Regulations 59A-31.014

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§ 59A-31.014 Overutilization Issues Raised in Reimbursement Dispute Resolution.

If the carrier, in its Carrier Response to Petition for Resolution of Reimbursement Dispute, asserts and submits documentation substantiating that a basis for disallowing petitioner's claim for payment is overutilization and the Agency, in its discretion, determines that the reimbursement dispute cannot be resolved without addressing the issue, the Agency will issue a determination pursuant to Section 440.13(7), F.S., that the reimbursement dispute cannot be resolved under Section 440.13(7), F.S., and is being converted to a proceeding under Sections 440.13(8) and 440.13(11), F.S.; or both.

Specific Authority 440.13(7)(e), 440.591 FS. Law Implemented 440.13(7)(b), 440.13(7)(c) FS. History: New 11-28-06.