Get the free Provider's Request for Reconsideration - State of Michigan
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Print Reset PROVIDER'S REQUEST FOR RECONSIDERATION Michigan Department of Licensing and Regulatory Affairs Workers Compensation Agency Health Care Services PO Box 30016, Lansing, MI 48909 Provider
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What is provider's request for reconsideration?
Provider's request for reconsideration is a formal request made by a healthcare provider to have a decision or payment amount reconsidered by a payer.
Who is required to file provider's request for reconsideration?
The healthcare provider or their authorized representative is required to file the provider's request for reconsideration.
How to fill out provider's request for reconsideration?
Provider's request for reconsideration should be filled out with all relevant information, including the reason for reconsideration, supporting documentation, and any additional details requested by the payer.
What is the purpose of provider's request for reconsideration?
The purpose of provider's request for reconsideration is to appeal a decision made by a payer regarding reimbursement or coverage for healthcare services.
What information must be reported on provider's request for reconsideration?
Provider's request for reconsideration must include patient information, service details, original claim information, reason for reconsideration, and any additional supporting documentation.
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