Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. SB 860
       
       
       
       
       
       
                                Barcode 793356                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/09/2013           .                                
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       The Committee on Banking and Insurance (Negron) recommended the
       following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 311 - 343
    4  and insert:
    5         (a) Any health care provider, carrier, or employer who
    6  elects to contest the disallowance or adjustment of payment by a
    7  carrier under subsection (6) must, within 45 30 days after
    8  receipt of notice of disallowance or adjustment of payment,
    9  petition the department to resolve the dispute. The petitioner
   10  must serve a copy of the petition on the carrier and on all
   11  affected parties by certified mail. The petition must be
   12  accompanied by all documents and records that support the
   13  allegations contained in the petition. Failure of a petitioner
   14  to submit such documentation to the department results in
   15  dismissal of the petition.
   16         (b) The carrier must submit to the department within 30 10
   17  days after receipt of the petition all documentation
   18  substantiating the carrier’s disallowance or adjustment. Failure
   19  of the carrier to timely submit such the requested documentation
   20  to the department within 30 10 days constitutes a waiver of all
   21  objections to the petition.
   22         (c) Within 120 60 days after receipt of all documentation,
   23  the department must provide to the petitioner, the carrier, and
   24  the affected parties a written determination of whether the
   25  carrier properly adjusted or disallowed payment. The department
   26  must be guided by standards and policies set forth in this
   27  chapter, including all applicable reimbursement schedules,
   28  practice parameters, and protocols of treatment, in rendering
   29  its determination.
   30         (d) If the department finds an improper disallowance or
   31  improper adjustment of payment by an insurer, the insurer shall
   32  reimburse the health care provider, facility, insurer, or
   33  employer within 30 days, subject to the penalties provided in
   34  this subsection.
   35         (e) The department shall adopt rules to carry out this
   36  subsection. The rules may include provisions for consolidating
   37  petitions filed by a petitioner and