Current through Register Vol. 54, No. 19, May 11, 2024
Section 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).The provisions of this § 127.252 amended January 16, 1998, effective 1/17/1998, 28 Pa.B. 329. This section cited in 34 Pa. Code § 127.207 (relating to downcoding by insurers).