راهنمای ارائه دهنده

روند شنیدن عادلانه

وقتی PAC اعتبار سنجی ، اعتبار سنجی مجدد را رد می کند ، مجازات صادر می کند یا ارائه دهنده ای را از شبکه خاتمه می دهد ، ارائه دهندگان ممکن است سطح دوم درخواست تجدید نظر را بخوانند ، دادرسی منصفانه. درخواست رسیدگی عادلانه باید ظرف 30 روز از تاریخ اطلاع PAC انجام شود. ارائه دهنده اخطار کتبی درباره مکان ، زمان و تاریخ دادرسی عادلانه را دریافت می کند ، تاریخ که کمتر از 30 روز از تاریخ دریافت درخواست تجدید نظر از ارائه دهنده نخواهد بود.

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.