Manwal ng Tagabigay

PROSESO NG PATATAS NA PAGDINIG

Maaaring humiling ang mga provider ng pangalawang antas ng apela, Fair Hearing, kapag tinanggihan ng PAC ang kredensyal, pagre-recredensyal, nag-isyu ng parusa o winakasan ang isang provider mula sa network batay sa mga isyung nauugnay sa kakayahan o propesyonal na pag-uugali. Ang isang kahilingan para sa isang Makatarungang Pagdinig ay dapat gawin sa loob ng 30 araw mula sa petsa ng abiso ng PAC. Makakatanggap ang provider ng nakasulat na paunawa ng lugar, oras at petsa ng Fair Hearing, na ang petsa ay hindi dapat bababa sa 30 araw pagkatapos ng petsa na natanggap ang kahilingan para sa apela mula sa provider.

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.