Two-tiered appeal process

Two-tiered appeal process

If you have claims that have been rejected or adjusted by MSI, you may have the right to appeal. Both pre-payment assessment and post-payment audit disputes will proceed through this process.

Facilitated resolution

Facilitated resolution proceeds in accordance with Schedule C of the Commercial Arbitration Act (except for clauses 2, 15 and 16). You will meet with the DHW medical consultant, the DNS medical consultant, MSI audit personnel and a facilitator, with a goal to resolve the issue through conversation and education. Legal counsel is not permitted to attend facilitated resolution.

If an agreement is not reached, you have 30 business days to provide file a Notice of Intent to Proceed to Arbitration.

Arbitration by resolution panel

Cases that proceed to arbitration by resolution panel will be heard by a panel made up of a physician, a lawyer and a member of the public. You may have legal representation present at the arbitration. The panel will review the dispute and make a final binding decision by majority vote. The official decision will be rendered within 10 days.

Amounts owed by you or the DHW will be due and payable on the date of the decision and will bear interest of prime + 2% from that day.


Jessica Moore
Compensation manager, Physician Agreement and Fee Schedule