Sec. 325-6.5. Eligibility for arbitration  


Latest version.
  • (a) Except as provided in subdivision (b) of this section, all claims for reimbursement by a health insurer which have been timely served in accordance with the provisions of section 325-6.2 of this Subpart are eligible for and subject to mandatory arbitration to be conducted under this Subpart provided the carrier:
    (1) fails to make full payment or serve an objection within 90 days after the date of service of the HIMP-1 form by the health insurer on the carrier; or
    (2) serves an objection to reimbursement to the health insurer within 90 days after the date of service of the HIMP-1 form by the health insurer.
    (b) Claims for reimbursement that has not been established, either by acceptance of the claim or by board finding of ANCR, are ineligible for arbitration.