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AS 47.05.200 AS 47.07.040 7 AAC 105.270. First-level provider appeal. (a) A provider may request a first-level appeal of a denied or reduced claim or service under this section if no later than 180 days after the date on the remittance advice for the claim, a provider submits to the department’s designee

(1) a written request for a first-level appeal of the denied or reduced claim or service that specifies the basis upon which the decision is challenged and includes any supporting documentation;

(2) a copy of the original denied or reduced claim and attachments;

(3) a copy of the remittance advice relating to the denied or reduced claim; and

(4) if applicable, an adjustment or void request completed by the provider correcting the information submitted with the original claim. (b) In an appeal under (a) of this section of a decision that denied the payment of a claim based on the provider’s failure to file the claim before the billing deadline under 7 AAC 145.005(c), the department’s designee shall

(1) approve the appeal and pay the maximum amount allowed under 7 AAC 105 — 7 AAC 160 if the department’s designee determines that

(A) the department committed an error on a claim previously submitted by the provider for the same service to the same recipient on the same day;

(B) the claim was timely filed but not processed; or

(C) the provider has good cause under 7 AAC 105.280(h) for the provider’s failure to submit the claim before the billing deadline under 7 AAC 145.005(c); or

(2) deny the provider’s appeal if the department’s designee determines that the claim was not timely filed. (c) A provider may request a first-level appeal of a noncertification of hospital admission or length of stay that, under 7 AAC 105 — 7 AAC 160, requires prior approval by a quality improvement organization, if no later than 180 days after the date of the noncertification of the hospital admission or length of stay notice, a provider submits to the quality improvement organization

(1) a written request for a first-level appeal that specifies the basis upon which the decision is challenged and includes any supporting documentation;