34 Pa. Code § 127.252 - Application for fee review-filing and service
(a) Providers seeking review of fee disputes
shall file the original and one copy of a form prescribed by the Bureau as an
application for fee review. The application shall be filed no more than 30 days
following notification of a disputed treatment or 90 days following the
original billing date of the treatment which is the subject of the fee dispute,
whichever is later. The form shall be accompanied by documentation required by
§
127.253 (relating to application
for fee review-documents required generally).
(b) Providers shall serve a copy for the
application for fee review, and the attached documents, upon the insurer. Proof
of service shall accompany the application for fee review and shall indicate
the person served, the date of service and the form of service.
(c) Providers shall send the application for
fee review and all related attachments to the address for the Bureau listed on
the application form.
(d) The time
for filing an application for fee review will be tolled if the insurer has the
right to suspend payment to the provider due to a dispute regarding the
reasonableness and necessity of the treatment under Subchapter C (relating to
medical treatment review).
Notes
This section cited in 34 Pa. Code § 127.207 (relating to downcoding by insurers).
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