Section R. 500.62 - Scope and applicabilityRule 62. These rules do all of the following:
(a) Establish criteria and standards for utilization review that identify utilization of treatment, training, products, services, and accommodations provided to an injured person for the injured persons care, recovery, or rehabilitation as required under section 3107(1)(a) of the act, MCL 500.3107(1)(a), above the usual range of utilization, based on medically accepted standards.(b) Establish procedures for all of the following: (i) Acquisition of necessary records, medical bills, and other information concerning the treatment, training, products, services, and accommodations provided to an injured person.(ii) For an insurer and for the association to request an explanation for, and requiring a provider to explain, the reasonable necessity or indication for treatment, training, products, services, and accommodations provided to an injured person.(iii) Provider appeals to the department from an insurers or the associations determination that the provider overutilized or otherwise rendered or ordered inappropriate treatment, training, products, services, and accommodations, or that the cost of the treatment, training, products, services, and accommodations was inappropriate under chapter 31 of the act, MCL 500.3101 to 500.3179, and rules promulgated thereunder.(c) Apply to treatment, training, products, services, and accommodations provided after July 1, 2020, to an injured person who is insured under a policy of no-fault automobile insurance issued under chapter 31 or chapter 31A of the act, MCL 500.3101 to 500.3179 and 500.3181 to 500.3189.(d) Apply to all insurers providing personal protection insurance under chapter 31 of the act, MCL 500.3101 to 500.3179 or under chapter 31A of the act, MCL 500.3181 to 500.3189, and to the association. Nothing in these rules should be construed to limit the ability of insurers and the catastrophic claims association to contract with a medical review organization to perform utilization review activities on their behalf. An insurer that uses a medical review organization remains responsible for complying with the act and any rules promulgated thereunder.Mich. Admin. Code R. 500.62
2020 MR 24, Eff. 12/18/2020