Section R9-34-406. Filing a Claim Dispute From a Contractor for Reinsurance

A.       A contractor shall file a written reinsurance claim dispute with AHCCCS under the timelines in A.R.S. § 36-2903.0l(B)(4).

B.       AHCCCS shall mail a written Notice of Decision of the claim dispute for reinsurance to the contractor no later than 30 days after the contractor files the claim dispute with AHCCCS, unless AHCCCS and contractor agree to a longer period.

C.       AHCCCS' written Notice of Decision shall include:

1.       The date of the decision,

2.        The factual and legal basis for the decision,

Title      Ch. 34                                                                              Administrative Code

Arizona Health Care Cost Containment System - Grievance System

3.        The contractor's right to request a State Fair Hearing under A.RS. § 41-1092, et seq., and

4.        The manner in which a contractor is to fiie a State Fair Hearing request under A.RS. § 41-1092 et seq.

D.       A contractor may request a State Fair Hearing on AHCCCS' Notice of Decision if:

1.       The contractor files a written request for a State Fair Hearing with AHCCCS no later than 30 days after the date the contractor receives the AHCCCS' written Notice of Decision regarding reinsurance, or

2.        AHCCCS does not render a written Notice of Decision regarding reinsurance within 30 days after the claim dis­ pute is filed and the contractor files a written request for a State Fair Hearing within 30 days after the date that the Notice of Decision should have been mailed.

E.       AHCCCS shall mail a notice of a State Fair Hearing under A.RS. § 41-1092.05 if AHCCCS receives a timely request for a State Fair Hearing from the contractor.

F.        AHCCCS shall mail a Director's Decision to the contractor no later than 30 days after the date the Administrative Law Judge sends the OAH decision to AHCCCS.

G.       AHCCCS shall accept a written request for withdrawal if the written request for withdrawal is received from the contractor before AHCCCS mails a notice of hearing under A.R.S. § 41- 1092, et seq. If AHCCCS mailed a Notice of Hearing under A.RS. § 41-1092, et seq., a contractor shall send a written request for withdrawal to OAH.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).