14684.1. (Amended by Stats. 2012, Ch. 34, Sec. 242.)
(a)The department shall establish a process for second…#
(a) The department shall establish a process for second level treatment authorization request appeals to review and resolve disputes between mental health plans and hospitals.
(b)When the department establishes an appeals process, the…#
(b) When the department establishes an appeals process, the department shall comply with all of the following:
(1) The department shall review appeals initiated by hospitals and render decisions on appeals based on findings that are the result of a review of supporting documents submitted by mental health plans and hospitals.
(2) If the department upholds a mental health plan denial of payment of a hospital claim, a review fee shall be assessed on the provider.
(3) If the department reverses a mental health plan denial of payment of a hospital claim, a review fee shall be assessed on the mental health plan.
(4) If the department decision regarding a mental health plan denial of payment upholds the claim in part and reverses the claim in part, the department shall prorate the review fee between the parties accordingly.