Frequently Asked Questions

• The health care provider may appeal to DIFS within 90 days of the date of the disputed determination from the auto insurer or Michigan Catastrophic Claims Association (MCCA).
• DIFS will send a copy of the Notice of Appeal via email to the parties within 14 days of accepting a provider appeal request.
• The auto insurer or MCCA has the option to reply to DIFS’ Notice of Appeal within 21 days by completing the Auto Insurance Utilization Review Insurer Reply to Provider Appeal form.
• DIFS will issue an order within 28 days after the insurer files any reply to a provider’s appeal or within 28 days after the time for filing a reply has expired if the insurer does not file a reply. DIFS may, upon sending written notice to both parties, take an additional 28 days to issue an order.

If the health care provider and auto insurer resolve their UR dispute prior to DIFS issuing a decision, the health care provider should email the DIFS staff member listed on the Notice of Appeal and request a withdrawal of the appeal in writing. If the health care provider does not have the staff member’s email address, the health care provider should send the request for withdrawal to DIFS-URAppeals@michigan.gov. DIFS will issue a Settlement of Disputed Determination to both parties and formally close the appeal request.

The parties may obtain an update as to the status of the appeal by emailing DIFS-URAppeals@michigan.gov and providing the injured person’s name and the case number assigned to the appeal.

If you received a determination from the auto insurer for additional dates of service not currently under review by DIFS, please email a separate Auto Insurance Utilization Review Provider Appeal Request (FIS 2356) form and supporting documentation, specific to the additional dates of service, to DIFS-URAppeals@michigan.gov within 90 days of the date of the disputed determination.

No.

You must submit a Freedom of Information Act (FOIA) request to obtain copies of documents in the possession of the DIFS. For more information on how to submit a FOIA request, please visit Michigan.gov/DIFSfoia. Redacted orders can be found at Michigan.gov/AutoInsuranceUR.

In general, every insurer providing PIP in Michigan must:

• Establish procedures to acquire sufficient documentation to enable the insurer to identify overutilized or otherwise inappropriate treatment, products, training, services, or accommodations provided after July 1, 2020, to an injured person who is insured under a policy of no-fault automobile insurance (or that the cost of that treatment, etc. was inappropriate under chapter 31 of the Insurance Code, MCL 500.3101, et seq.)
• Retain all information gathered under the UR Rules for at least two years.
• Submit any requests, explanations, and/or determinations issued under the UR Rules to DIFS upon request.
• Submit any requests for additional information or explanation from the provider within 30 days of the insurer’s receipt of the disputed bill.
• Issue a written notice of the insurer’s determination to the provider within 30 days of receipt of the provider’s written explanation.
• Ensure a written notice of the insurer’s determination satisfies all required components outlined in Mich Admin Code, R 500.64.
• Choose to respond to a provider’s appeal within 21 days of receiving DIFS’ issued notice of provider appeal.

For additional information regarding insurers’ obligations related to UR, please see DIFS’ Statutes, Rules and Regulations.

No. The auto insurer’s UR program must be in place before applying for certification. If there are any deficiencies in the insurer’s application, DIFS will issue a conditional certification, after which the insurer will have up to one year to correct any deficiencies.

Yes, but only if the following is true: (1) the contact information noted on the application form is the same for all included companies; and (2) the UR program must be the same for all included companies. When completing one application for multiple companies and NAIC numbers, please include a separate attachment listing all company names and NAIC numbers. Note: Separate applications must be submitted for each company and NAIC number if any of the companies’ UR programs differ in any way.

No. The auto insurer is responsible for submitting the application to DIFS. The contact information and signature in the application must be provided by an individual authorized by the insurer.

Yes. The Director may revoke a certification upon a finding that an insurer has either failed to comply with any of DIFS’ UR Rules or has failed to satisfactorily complete a corrective action plan.

If an insurer is no longer writing auto insurance in Michigan and does not have any active PIP claims, they do not need to have an active UR certification on file with DIFS. If an insurer does not require a UR certification, they must email DIFS-URCertification@michigan.gov noting the reason they no longer require UR certification with DIFS.

Pursuant to Mich Admin Code, R 500.64, the written notice of determination should include the following:

• Criteria or standards the insurer relied on for its determination.
• Amount of payment to the provider that has been made based on the determination, including an explanation for the difference between the payment amount and the amount billed by the provider.
• A description of any additional records the provider must submit to the insurer for the insurer to reconsider its determination.
• A copy of the Auto Insurance Utilization Review Provider Appeal Request (FIS 2356).
• The date of the determination.

• The health care provider may appeal to DIFS within 90 days of the date of the disputed determination from the auto insurer or Michigan Catastrophic Claims Association (MCCA).
• DIFS will send a copy of the Notice of Appeal via email to the parties within 14 days of accepting a provider appeal request.
• The auto insurer or MCCA has 21 days to reply to DIFS’ Notice of Appeal by completing the Auto Insurance Utilization Review Insurer Reply to Provider Appeal form, if desired.
• DIFS will issue an order within 28 days after the insurer files any reply to a provider’s appeal or within 28 days after the time for filing a reply has expired if the insurer does not file a reply. DIFS may, upon sending written notice to both parties, take an additional 28 days to issue an order.

Yes. Insurers with a certified utilization review program must promptly update their contact information via the Auto Insurance Information Portal if there are any changes.