REVIEW OF MEDICAL FEE DISPUTES

A provider who has submitted the required bills and reports to an insurer and who disputes the amount or timeliness of the payment made by an insurer, shall have standing to seek review of the fee dispute by the Bureau.

Notes of Decision

A fee review officer has no authority to decide the issue of liability in a fee review proceeding. The issue for a fee review officer is the ‘‘amount and timeliness of the payment made by an insurer.’’ Nickel v. Workers’ Comp. Appeal Bd. (Agway Agronomy), 959 A.2d 498, 503 (Pa. Cmwlth. 2008).

Cross References

This section cited in 34 Pa. Code § 127.302 (relating to resolution of self-referral disputes by Bureau).