18 Del. Admin. Code § 1319-3.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1319-3.0 - Notice of Final Reimbursement Decision

3.1 A carrier shall notify a provider, in writing, of a carrier's final decision regarding reimbursement for an individual claim, procedure or service, if the decision does not authorize reimbursement of the provider's charge in accordance with 18 Del.C. §§ 3342B and 3556A. Such notice may be separate from or a part of the written notice of the carrier's decision.

3.2 Any notice given to a provider pursuant to subsection 3.1 shall:

3.2.1 Be in writing; and

3.2.2 Give the provider notice of the provider's right to arbitration through the Department's arbitration program, by including, at a minimum, the following language:

"You have the right to seek review of our decision regarding the amount of your reimbursement. The Delaware Insurance Department provides claim arbitration services which are in addition to, but do not replace, any other legal or equitable right you may have to a review of this decision or any right of review based on your contract with us. You can contact the Delaware Insurance Department for information about arbitration by calling the Arbitration Secretary at 302-674-7322 or by sending an email to: DOI-arbitration@delaware.gov. All requests for arbitration must be filed within 60 days from the date you receive this notice; otherwise, this decision will be final."

18 Del. Admin. Code § 1319-3.0

23 DE Reg. 314 (10/1/2019) (final)