(a) If an out-of-network provider concludes that payment received from an insurer pursuant to Code Section 33-20E-4 or 33-20E-5 or if an out-of-network facility concludes that payment received from an insurer pursuant to Code Section 33-20E-4 is not sufficient given the complexity and circumstances of the services provided, the provider or facility may initiate a request for arbitration with the Commissioner. Such provider or facility shall submit such request within 60 days of receipt of such payment for the claim and concurrently provide the insurer with a copy of such request. Such payment shall be indicated by the insurer on the first page of the insurer's remittance to the out-of-network provider in a manner to be determined by the Commissioner through the promulgation of rules and regulations. Such rules and regulations shall specify when the time period to request arbitration commences.(b) A request for arbitration may involve a single patient and a single type of healthcare service, a single patient and multiple types of healthcare services, multiple patients and a single type of healthcare service, or multiple substantially similar healthcare services in the same hcare service, a single patient and multiple types of healthcare services, multiple patients and a single type of healthcare service, or multiple substantially similar healthcare services in the same specialty on multiple patients.Amended by 2023 Ga. Laws 223,§ 3, eff. 7/1/2023.Added by 2020 Ga. Laws 470,§ 1, eff. 1/1/2021.
Georgia Legal Code