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Medical Fee Review

 Content Editor ‭[1]‬

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, whichever is later.