Medical Fee Review

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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
BUREAU OF WORKERS' COMPENSATION
1171 South Cameron Street, Room 305
Harrisburg, PA 17104-2501
717-886-9110
 

When an injured worker receives medical treatment, providers are subject to sections of the Pennsylvania Workers’ Compensation Act and Chapter 127 Workers’ Compensation Medical Cost Containment Regulations which establish reimbursement for the Pennsylvania Workers’ Compensation program. Providers may dispute the timeliness or amount of payment received by utilizing the medical fee review process.

When medical services are properly billed and a Workers’ Compensation Medical Report Form (LIBC-9) has been received, a payer has 30 days to process the bill. If providers do not receive timely or correct payment, an Application for Fee Review may be filed online within the Workers’ Compensation Automation and Integration System (WCAIS) within 90 days of the original billing or 30 days from the date of dispute notification.

Upon receipt of a fee review decision, an interested party may request a de novo appeal within 30 days of the decision. Fee Review Hearing Officers will render a decision on the matter after reviewing all evidence presented by the parties.

Providers who receive a fee review finding in their favor may report payer noncompliance with the fee review decision within WCAIS.