Section R. 418.101205 - Scope of professional health care reviewRule 1205.
(1) The carrier, or it's review company, shall review case records and health-service bills, or both, under the professional health care review program as follows: (a) A case where health care service payments, excluding inpatient hospital care, exceed $20,000.00.(b) A case involving inpatient hospital care.(2) The carrier or other entity may at any time review any case record or bill which the carrier or the other entity believes may involve inappropriate, insufficient, or excessive care.Mich. Admin. Code R. 418.101205