In my last newsletter, I stated that “bills must be sent out by the carrier to the PRO within 30 days of receipt.” Carriers actually have 90 days to refer a file to a PRO. However, if a carrier does so after 30 days, the carrier is obligated to pay the provider’s bill pending PRO review. Providers should be aware that if the peer review finds that the care was not medically necessary, the provider is responsible for repayment of funds received for that care with interest.
