Library: Policy

317:30-3-23. Reconsideration request

Revised 7-25-08

     If the QIO, upon their initial review determines the admission should be denied, a notice is issued to the facility and the attending physician advising them of the decision and advising them that a reconsideration request may be submitted in accordance with the Medicare time frame.  Additional information submitted with the reconsideration request will be reviewed by the QIO who utilizes an independent physician advisor.  If the denial decision is upheld through this reconsideration review of additional information, OHCA is informed.  At that point OHCA sends a letter to the hospital and physician requesting a refund of the SoonerCare payment previously made on the denied admission.  The member is not responsible for denied charges.