Manual do Provedor

PROCESSO DE AUDIÊNCIA JUSTA

Os provedores podem solicitar um segundo nível de recurso, Audiência Justa, quando o PAC nega credenciamento, recredenciamento, emite uma sanção ou encerra um provedor da rede com base em questões relacionadas à competência ou conduta profissional. Uma solicitação de Audiência Justa deve ser feita dentro de 30 dias a partir da data da notificação do PAC. O provedor receberá uma notificação por escrito do local, hora e data da Audiência Justa, cuja data não deve ser inferior a 30 dias após a data em que o pedido de apelação foi recebido do provedor.

Additionally, the provider will receive an explanation of the hearing procedures, and a list of witnesses, if any, expected to testify on behalf of Carelon. The Chair of the PAC will identify peer reviewers who will participate as the Fair Hearing Panel, assuring representation of the discipline of the practitioner requesting the appeal. These peers will not have any economic interest adverse to provider, nor will they have participated in the decisions of the PAC or NCC. One member of the Fair Hearing Panel will be selected to act as the hearing officer and will preside over the Fair Hearing. Both Carelon and the provider will make reasonable efforts to establish a mutually agreed upon date for the hearing. Both Carelon and the provider have the right to legal representation at the Fair Hearing. The provider will receive a written recommendation from the panel within 15 business days after the Fair Hearing. The Fair Hearing process as set forth above is subject to applicable state and federal law.