Florida Regulations 59A-31.004

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§ 59A-31.004 Carrier Response Form.

(1) The Carrier Response to Petition for Resolution of Reimbursement Dispute Form (AHCA Form 3160-0024, effective September 8, 2006) is hereby incorporated by reference. This form may be obtained on the Internet at http://www.fldfs.com/wc/forms.html or by contacting the Agency at (850)413-1613.

(2) The Carrier Response to Petition for Resolution of Reimbursement Dispute Form shall be considered a required element of the requested documentation to the Agency under Section 440.13(7)(b), F.S. The Carrier Response to Petition for Resolution of Reimbursement Dispute Form shall be the only form accepted by the Agency upon which a carrier may submit to the Agency its response to a Petition for Resolution of Reimbursement Dispute. Any submission by a carrier pursuant to Section 440.13(7)(b), F.S., that does not include a completed Carrier Response to Petition for Resolution of Reimbursement Dispute Form shall result in a notice of deficiency by the Agency. A carrier shall have ten (10) calendar days from receipt of the notice of deficiency to cure the deficiency identified in the Agency's notice of deficiency. Failure to timely cure the deficiency shall constitute failure to submit requested documentation to the Agency.

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