It is very important that all treatment gets billed on the proper forms, within 30 days, and with the corresponding medical reports. Any failure to meet the billing requirements under the Work Comp Act will be used as a way for the insurer to wiggle out of payment.
As a reminder, please note that requests for payment of medical bills shall be made on the HCFA Form 1500 or the UB92 Form, or any successor forms for submission of Medicare claims. Also, providers who treat injured employees are required to submit periodic medical reports, commencing 10 days after treatment begins and at least once a month thereafter as long as treatment continues. If treatment is not on a proper form, or if the reports aren’t sent, the insurer is not obligated to pay for the treatment until same is received by the insurer. Payments for treatment rendered under the Act shall be made within 30 days of receipt of the bill and report submitted by the provider.
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In addition, 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 (Fee Review) by the Bureau. Providers seeking review shall file the original and one copy of a form prescribed by the Bureau as an application for Fee Review, and 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- whichever is later. A copy of the application and the attached documents, shall be served upon the insurer, with a proof of service. For more information on Fee Review, see the cost containment regs at Sections 127.251 and continuing.
If you need help in getting medical treatment paid for in a Pennsylvania Workers’ Compensation case, please feel free to contact PA Work Comp Specialist, Michael W. Cardamone at 215.206.9068 of Cardamone Law or via email at Michael@CardamoneLaw.com
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