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This version of the form is not currently in use and is provided for reference only. Download this version of
Form FIS2361
for the current year.
Form FIS2361 No-Fault Utilization Review Insurer Reply to Provider Appeal - Michigan
What Is Form FIS2361?
This is a legal form that was released by the Michigan Department of Insurance and Financial Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form FIS2361?
A: Form FIS2361 is a No-Fault Utilization Review Insurer Reply to Provider Appeal form in Michigan.
Q: What is the purpose of Form FIS2361?
A: The purpose of Form FIS2361 is to respond to a provider's appeal regarding a utilization review decision in Michigan's No-Fault insurance system.
Q: Who uses Form FIS2361?
A: This form is used by insurers in Michigan to reply to provider appeals in the No-Fault utilization review process.
Q: What information is required in Form FIS2361?
A: Form FIS2361 requires the name of the insurance company, the date of the appeal reply, the provider's name and address, the details of the utilization review decision being appealed, and the insurer's response to the appeal.
Form Details:
- Released on December 1, 2020;
- The latest edition provided by the Michigan Department of Insurance and Financial Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FIS2361 by clicking the link below or browse more documents and templates provided by the Michigan Department of Insurance and Financial Services.
Download Form FIS2361 No-Fault Utilization Review Insurer Reply to Provider Appeal - Michigan
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