Statutes, codes, and regulations
Pennsylvania Code (Rules and Regulations)
Title 34 - LABOR AND INDUSTRYPart VIII - Bureau of Workers' CompensationChapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENTSubchapter B - MEDICAL FEES AND FEE REVIEW
REVIEW OF MEDICAL FEE DISPUTES
Section 127.254 - Downcoding disputes

34 Pa. Code § 127.254

Download
PDF
Current through Register Vol. 54, No. 49, December 7, 2024
Section 127.254 - Downcoding disputes
(a) When changes in procedure codes are the basis for a fee dispute, the Bureau will give the provider and the insurer the opportunity to produce copies of written communications concerning the changes in procedure codes.
(b) If an insurer has not complied with § 127.207 (relating to downcoding by insurers) the Bureau will resolve downcoding disputes in favor of the provider.

34 Pa. Code § 127.254

This section cited in 34 Pa. Code § 127.207 (relating to downcoding by insurers).