Library: Policy

3172-3-14. Administrative Law Judge (ALJ) jurisdiction

Revised 9-12-22

        The ALJ has jurisdiction of the following matters:

(1) Member State fair hearing. The ALJ has jurisdiction to hear any State fair hearing arising from a member's MCE appeal of an adverse benefit determination.

(2) Provider State fair hearing. The ALJ has jurisdiction to hear any State fair hearing arising from a provider's appeal of audit findings, for-cause or immediate termination of the provider's contract with the MCE, or claims denial.