Rule 120-2-111-.13 - Fees for Independent Review(1) Any reviews which involve either a Medical Doctor or a Doctor of Osteopathy will be tier-one reviews with a flat fee of $ 1,500.(2) All other type of reviews shall be tier-two reviews with a flat fee of $ 1,000.(3) The fees referenced above shall be the flat rate for the applicable type of review, and the independent review organizations may also bill the managed care entities for their costs incurred in the review. Such costs are intended to include such items as photocopying, facsimile, postage, package delivery, and courier costs.(4) Independent review organizations shall bill the managed care entity directly for the fees and costs of independent review.(5) Managed Care Entities shall pay independent review organizations directly within 30 days of receipt of an invoice.(6) Failure to Pay Invoice. Failure by a managed care entity to pay invoices from independent review organization within 30 days of receipt shall constitute a violation subject to the penalty referenced under the Act, and codified at O.C.G.A. § 33-20A-35.Ga. Comp. R. & Regs. R. 120-2-111-.13
O.C.G.A. §§ 33-2-9, 33-20A-41.
Original Rule entitled "Fees for Independent Review" adopted. F. Sept. 20, 2023; eff. August 1, 2023, as specified by the Agency.