108C-12. Appeals by Medicaid providers and applicants.
(a) General Rule. - Notwithstanding any provision of State law or rules to the contrary, this section shall govern the process used by a Medicaid provider or applicant to appeal an adverse determination made by the Department.
(b) Appeals. - Except as provided by this section, a request for a hearing to appeal an adverse determination of the Department under this section is a contested case subject to the provisions of Article 3 of Chapter 150B of the General Statutes.
(c) Final Decision. - The Office of Administrative Hearings shall make a final decision within 180 days of the date of filing of the appeal with the Office of Administrative Hearings. The time to make a final decision shall be extended in the event of delays caused or requested by the Department.
(d) Burden of Proof. - The petitioner shall have the burden of proof in appeals of Medicaid providers or applicants concerning an adverse determination. (2011-399, s. 1; 2014-100, s. 12H.27(a).)
Structure North Carolina General Statutes
North Carolina General Statutes
Chapter 108C - Medicaid Provider Requirements
§ 108C-1 - (Effective until contingency met see note) Scope; applicability of this Chapter.
§ 108C-2 - (Effective until contingency met see note) Definitions.
§ 108C-2.1 - Provider application and revalidation fee.
§ 108C-3 - (Effective until contingency met see note) Medicaid and Health Choice provider screening.
§ 108C-5 - Payment suspension and audits utilizing extrapolation.
§ 108C-5.1 - Post-payment review and recovery audit contracts.
§ 108C-6 - Agents, clearinghouses, and alternate payees; registration required.
§ 108C-7 - Prepayment claims review.
§ 108C-8 - (Effective until contingency met see note) Threshold recovery amount.
§ 108C-9 - (Effective until contingency met see note) Provider enrollment criteria.
§ 108C-10 - Change of ownership and successor liability.
§ 108C-11 - Cooperation with investigations and audits.