(a) Statement of disputes. The statement of disputes
is a written description of the dispute(s) to be considered by the
arbitrator. A dispute not expressly included in the statement of disputes
will not be considered by the arbitrator.
(b) Statement of disputes after a benefit review conference.
The statement of disputes for an arbitration proceeding conducted
after a benefit review conference includes:
(1) the benefit review officer's report, identifying
the disputes remaining unresolved at the close of the benefit review
conference;
(2) the parties' responses to the benefit review officer's
report, if any; and
(3) additional disputes by unanimous consent, as provided
by subsections (c) and (d) of this section.
(c) Additional disputes by unanimous consent. Parties
may, by unanimous consent, submit for inclusion in the statement of
disputes one or more disputes not identified as unresolved in the
benefit review officer's report. Additional disputes submitted by
consent shall:
(1) be made in writing;
(2) identify the dispute and explain each party's position
on it;
(3) be signed by all parties;
(4) be sent to the division's chief clerk of proceedings
no later than 10 days before the arbitration proceeding; and
(5) explain why the issue was not raised earlier.
(d) The statement of dispute in the arbitration of
a medical fee dispute may not include a dispute regarding compensability,
extent of injury, liability, or medical necessity for the same service
for which there is a medical fee dispute. Chapter 133, Subchapter
D of this title (relating to Dispute of Medical Bills) requires parties
to resolve such disputes prior to requesting medical fee dispute resolution
by the division. If a party provides the arbitrator with documentation
listed in §133.307(d)(2)(H) or (I) of this title (relating to
MDR of Fee Disputes) that shows unresolved issues regarding compensability,
extent of injury, liability, or medical necessity for the same service
subject to the fee dispute, then the arbitrator shall abate the arbitration
proceedings until those issues have been resolved.
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