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Michigan’s surprise medical billing law requires the Michigan Department of Insurance and Financial Services (DIFS) to administer certain aspects of the law. These responsibilities include reviewing a carrier’s calculation of its negotiated median amount upon a nonparticipating provider’s request facilitating arbitration and preparing an annual report. Administrative Rules applicable to requests for calculation reviews and to the approval of arbitrators became effective on June 24, 2021.
Provider Requests for Calculation Reviews
A nonparticipating provider who believes that a carrier incorrectly calculated its negotiated median amount when providing payment to the provider pursuant to MCL 333.24507(2)(a) or MCL 333.24509(5)(a), may submit a request to DIFS for a review of the calculation.
Nonparticipating providers must submit the request for a calculation review by completing the Request for Review of Calculation of Charges form (FIS 2369). The form must be submitted to DIFS by email to DIFS-SurpriseBilling@michigan.gov or by fax to 517-763-0305.
Note: Under MCL 333.24510(3), a nonparticipating provider shall not file a subsequent request for a review if the request involves the same rate calculation for a health care service for which the provider has previously received a determination from DIFS.
Following the submission of a request for a calculation review, DIFS will notify the carrier and may request information DIFS believes is necessary to assist in reviewing the calculation described above.
Provider Requests for Binding Arbitration
A nonparticipating provider may file a claim with the carrier for an additional payment for health care services provided to certain emergency patients involving a complicating factor, as defined under the statute. The statute governs what documentation the provider must submit to the carrier and states that the carrier must respond within 30 days by denying the claim or making the additional payment, as calculated under the statute.
If the carrier denies the claim, the provider may submit a written request to DIFS for binding arbitration. Providers must submit the request for binding arbitration by completing the Request for Binding Arbitration form (FIS 2368). The form must be submitted to DIFS by email to DIFS-SurpriseBilling@michigan.gov or by fax to 517-763-0305.
Note: Failure to include the documentation required in the Request for Binding Arbitration form (FIS 2368) may result in a denial of the request for binding arbitration.
DIFS will notify the carrier following the acceptance of a request for binding arbitration. Under MCL 333.24511(4), within 30 days after receiving notice from DIFS, the carrier shall submit written documentation to DIFS confirming the denial or providing an alternative payment offer to be considered in arbitration.
Under MCL 333.24511(5), the parties must agree on an arbitrator from the DIFS Approved Arbitrator List. Providers and carriers are strongly encouraged to ensure they are consulting the list of approved arbitrators published when the arbitration process is commenced, as the list will be updated annually and may be updated more frequently, as necessary.
Approval of Arbitrators
Arbitrators who would like to apply for approval and inclusion on the DIFS Approved Arbitrators List must complete the Surprise Medical Billing Arbitrator form (FIS 2366). The form must be submitted to DIFS by email to DIFS-SurpriseBilling@michigan.gov or by fax to 517-763-0305.This must be submitted no later than 60 days before the arbitrator would like to begin providing arbitration services. Failure to include the documentation required in the form may result in a denial of the application. Applicants who have been denied may reapply at any time.
Approved arbitrators who are currently included on the DIFS Approved Arbitrators List must complete the Surprise Medical Billing Arbitrator form (FIS 2366) to do any of the following:
Approved arbitrators must submit the form to DIFS by email to DIFS-SurpriseBilling@michigan.gov or by fax to 517-763-0305.
Annual Report
DIFS is required to prepare and post online an annual report that includes certain information regarding complaints received and the number of requests made for calculation reviews and binding arbitration.
2023 Surprise Medical Billing Annual Report
2022 Surprise Medical Billing Annual Report
2021 Surprise Medical Billing Annual Report
2020 Surprise Medical Billing Annual Report
Contact Information
For carriers and providers:
DIFS-SurpriseBilling@michigan.gov
Phone: 877-999-6442
Fax: 517-763-0305
For consumers:
What Consumers Need to Know About Surprise Medical Billing
Phone: 877-999-6442
Request for Review of Calculation of Charges form (FIS 2369)
Request for Binding Arbitration form (FIS 2368)
Surprise Medical Billing Arbitrator form (FIS 2366)
Response to Calculation Review Request form (FIS 2370)
