20 Miss. Code R. § 2-IV

Current through June 25, 2024
Section 20-2-IV - PROCEDURE BY COST CONTAINMENT DIVISION
A. Requests for dispute resolution will be reviewed and decided by the Cost Containment Division of the MWCC after all required and requested information has been received. Additional time may be required to accommodate a Peer Review. The payer and/or provider may be contacted by telephone or other means for additional information if necessary; however, both parties to a dispute may submit in writing any information or argument they deem relevant to the issue in dispute, if not already submitted with the request for dispute resolution, and this information shall be considered by the Cost Containment Division when rendering a decision. Any written information or argument submitted for consideration by a party to a dispute, without a request from the MWCC, must be received by the Cost Containment Division within twenty-three (23) days after filing the Request for Resolution of Dispute in order to merit consideration. Unlike the Request for Resolution of Dispute Form, there is no specific prescribed form for a Response to such Request.
B. Every effort should be made by the parties to resolve disputes between themselves by telephone or in writing even after the filing of a Request for Resolution of Dispute. The payer and provider may be requested to attend an informal hearing conducted by a MWCC representative. Failure to appear at an informal hearing may result in dismissal of the Request for Resolution of Dispute. However, no formal hearing or oral argument shall be allowed unless requested by the Cost Containment Division and/or the MWCC. Otherwise, Requests for Resolution of Dispute shall be heard and considered solely on the record provided by the parties in the documentation they have submitted to the Cost Containment Division and any arguments they have made therein, without any oral argument or formal hearing.
C. Following review of all documentation submitted for dispute resolution and/or following contact with the payer and/or provider for additional information and/or negotiation, the Cost Containment Division shall render an administrative decision on the request for dispute resolution and forward it to the involved parties.
D. Cases involving medical care determination may be referred for peer review, but only on request of the MWCC. The peer review consultant will render an opinion and submit same to the MWCC representative within the time set by the Cost Containment Division. The MWCC representative will notify the parties in dispute if a Peer Review has been requested, and of the peer review consultant's determination.

20 Miss. Code. R. § 2-IV

Amended 6/14/2017
Amended 6/15/2019