H1846B3904A09990 BIL:NLH 10/06/14 #90 A09990







Printer's No. 3904


1Amend Bill, page 1, lines 11 through 14, by striking out all
2of said lines and inserting

3Section 1. Section 306(f.1)(3)(vi) and 5 of the act of June 
42, 1915 (P.L.736, No.338), known as the Workers' Compensation 
5Act, reenacted and amended June 21, 1939 (P.L.520, No.281) and 
6amended June 24, 1996 (P.L.350, No.57), are amended to read:

7Amend Bill, page 4, by inserting between lines 6 and 7

8(5) The employer or insurer shall make payment and providers
9shall submit bills and records in accordance with the provisions
10of this section. All payments to providers for treatment
11provided pursuant to this act shall be made within thirty (30)
12days of receipt of such bills and records unless the employer or
13insurer disputes the reasonableness or necessity of the
14treatment provided pursuant to paragraph (6). The nonpayment to
15providers within thirty (30) days for treatment for which a bill
16and records have been submitted shall only apply to that
17particular treatment or portion thereof in dispute; payment must
18be made timely for any treatment or portion thereof not in
19dispute. A provider who has submitted the reports and bills
20required by this section and who disputes the amount or
21timeliness of the payment from the employer or insurer shall
22file an application for fee review with the department no more
23than thirty (30) days following notification of a disputed
24treatment or ninety (90) days following the original billing
25date of treatment. If the insurer disputes the reasonableness
26and necessity of the treatment pursuant to paragraph (6), the
27period for filing an application for fee review shall be tolled
28as long as the insurer has the right to suspend payment to the
29provider pursuant to the provisions of this paragraph. Within
30thirty (30) days of the filing of such an application, the
31department shall render an administrative decision. If the
32administrative decision of the department upholds, in whole or
33in part, a provider's application for fee review which was filed
34for untimeliness of proper payment due, the employer or insurer
35shall be subject to the penalties in section 435(d) and, if the
36insurer's or employer's position is determined to be
37unreasonable, to reasonable costs and attorney's fees. The

1department shall include the award of attorney's fees and
2interest in the administrative decision and shall authorize a
3provider to submit a petition for attorney's fees concurrent
4with the filing of any document in support of the fee review
5petition. An administrative decision rendered by the department
6in favor of the provider's fee review petition, in whole or in
7part, shall be paid in full by the employer or insurer within
8thirty (30) days from the date of the department's
9administrative decision. Failure of an insurer to comply with
10this paragraph, absent the timely filing of an appeal under 2
11Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of
12Commonwealth agencies) shall create a right inuring to the
13benefit of the provider to obtain payment in full consistent
14with the department's administrative decision through a petition
15filed through penalty proceedings established by regulation of
16the department.

17* * *


See A09990 in
the context
of HB1846