Manual del proveedor

PROCESO DE AUDIENCIA IMPARCIAL

Los proveedores pueden solicitar un segundo nivel de apelación, Audiencia imparcial, cuando el PAC niega la acreditación, la nueva acreditación, emite una sanción o da de baja a un proveedor de la red en función de cuestiones relacionadas con la competencia o la conducta profesional. Se debe solicitar una audiencia imparcial dentro de los 30 días posteriores a la fecha de la notificación del PAC. El proveedor recibirá una notificación por escrito del lugar, la hora y la fecha de la audiencia imparcial, cuya fecha no será inferior a 30 días después de la fecha en que se reciba la solicitud de apelación del proveedor.

Additionally, the provider will receive an explanation of the hearing procedures, and a list of witnesses, if any, expected to testify on behalf of Carelon. The Chair of the PAC will identify peer reviewers who will participate as the Fair Hearing Panel, assuring representation of the discipline of the practitioner requesting the appeal. These peers will not have any economic interest adverse to provider, nor will they have participated in the decisions of the PAC or NCC. One member of the Fair Hearing Panel will be selected to act as the hearing officer and will preside over the Fair Hearing. Both Carelon and the provider will make reasonable efforts to establish a mutually agreed upon date for the hearing. Both Carelon and the provider have the right to legal representation at the Fair Hearing. The provider will receive a written recommendation from the panel within 15 business days after the Fair Hearing. The Fair Hearing process as set forth above is subject to applicable state and federal law.