Rule 511-5-10-.09 - Reconsideration of eligibility and claims decisions1) Patients, referring physicians, and other providers who are dissatisfied with the initial determination of the patient's eligibility for the Cancer State Aid Program may request reconsideration.2) Patients, referring physicians, hospitals, or other providers dissatisfied with a payment limitation or denial may request reconsideration.3) A request for initial reconsideration must be made in writing to the Program Director - Cancer State Aid Program, Department of Public Health. The request must be submitted within 30 days of the initial denial and should include a complete description and supporting scientific medical or financial information documenting reasons that the initial medical or financial determination was incorrect, or an exception to the payment limitation should be made.4) Requests for second reconsideration shall be forwarded to the Office of General Counsel, along with any reply that the Program deems appropriate, for an independent and impartial determination of whether the Program's decision was supported by the facts and made in accordance with the law and these regulations.5) The decision of the Office of General Counsel shall be final.Ga. Comp. R. & Regs. R. 511-5-10-.09
O.C.G.A. Secs. 31-2A-6, 31-15-5.
Previously rule 290-5-10-.09. Original Rule entitled "Reconsideration of eligibility and claims decisions" adopted. F. Apr. 11, 2012; eff. May 1, 2012.