Common use of PROVIDER RELATIONS COMMITTEE Clause in Contracts

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, a subcommittee of the BCBSM Board of Directors composed of BCBSM participating professionals, community leaders, and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility must represent itself at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "reasonable time"; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility is dissatisfied with the determination of the Provider Relations Committee, Facility may appeal the determination to the Michigan Office of Financial and Insurance Services, or initiate an action in an appropriate civil court.

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility Provider may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, Committee (PRC); a subcommittee of the BCBSM Board of Directors composed of BCBSM participating professionals, community leaders, and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility Provider must represent itself him/herself at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "reasonable time"; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Blue Cross Blue Shield of Michigan Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx J423 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility Provider is dissatisfied with the determination of the Provider Relations Committee, Facility Provider may appeal the determination to the Michigan Office of Financial and Insurance Services, Services or initiate an action in an appropriate civil state court.

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility Provider may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, Committee (PRC); a subcommittee of the BCBSM Board board of Directors directors composed of BCBSM participating professionals, community leaders, leaders and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility Provider must represent itself themselves at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "“reasonable time"”; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx MC J423 Blue Cross Blue Shield of Michigan 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility Provider is dissatisfied with the determination of the Provider Relations Committee, Facility he/she may appeal the determination to the Michigan Office of Financial and Insurance ServicesBureau, or initiate an action in an appropriate civil state court.

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, a subcommittee of the BCBSM Board board of Directors directors composed of BCBSM participating professionals, community leaders, and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility must represent itself at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "reasonable time"; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility is dissatisfied with the determination of the Provider Relations Committee, Facility may appeal the determination to the Michigan Office of Financial and Insurance ServicesOFIS, or initiate an action in an appropriate civil court.

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility Provider may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, Committee (PRC); a subcommittee sub-committee of the BCBSM Board board of Directors directors composed of BCBSM participating professionals, community leaders, and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility Provider must represent itself him/herself at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "reasonable time"; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Blue Cross Blue Shield of Michigan Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx J423 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility Provider is dissatisfied with the determination of the Provider Relations Committee, Facility Provider may appeal the determination to the Michigan Office of Financial and Insurance ServicesServices (OFIS), or initiate an action in an appropriate civil state court.

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility Provider may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, Committee (PRC); a subcommittee of the BCBSM Board of Directors composed of BCBSM participating professionals, community leaders, and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility Provider must represent itself him/herself at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "reasonable time"; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Blue Cross Blue Shield of Michigan Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx 423 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility Provider is dissatisfied with the determination of the Provider Relations Committee, Facility Provider may appeal the determination to the Michigan Office of Financial and Insurance ServicesBureau, or initiate an action in an appropriate civil state court.. MICHIGAN INSURANCE BUREAU

PROVIDER RELATIONS COMMITTEE. If dissatisfied with the decision of the IRC, Facility Provider may, within 30 days of receipt of the IRC determination, submit a written request for a review to the Provider Relations Committee, Committee (PRC); a subcommittee sub-committee of the BCBSM Board of Directors composed of BCBSM participating professionals, community leaders, and BCBSM senior management. BCBSM will acknowledge the receipt of the request and will schedule a meeting with the PRC within 90 days. Facility Provider must represent itself him/herself at this level of appeal and an advanced position statement is required. The determination of the PRC may or may not be rendered on the day of the hearing. The PRC’s mandate is to render a determination within a "reasonable time"; however these decisions will normally be rendered within 30 days of the date of the hearing. As such, BCBSM will communicate in writing the determination of the PRC within 30 days of the PRC’s determination. The request for a PRC hearing should be mailed to: Blue Cross Blue Shield of Michigan Director, Utilization Management Mail Code J 000 Xxxx Xxxxx Xxxx Xxxxxx xx Xxxxxxxx J423 000 X. Xxxxxxxxx Xxxx. Xxxxxxx, XX 00000-0000 If Facility Provider is dissatisfied with the determination of the Provider Relations Committee, Facility he/she may appeal the determination to the Michigan Office of Financial and Insurance Services, or initiate an action in an appropriate civil state court.