A fee review petition is held to be timely when filed within 90 days of billing date.

The claimant’s treating physician disputed the insurer’s payment of services by filing an application for fee review under section 306(f.1) (5) of the Act 85 days after the original billing date. The Bureau granted the fee petition. The insurer requested a de novo hearing, and the Hearing Officer found that the fee application was timely filed within 90 days. On appeal, the insurer argued that the provider failed to file its application within 30 days of the disputed treatment as provided by the Act and that the 90-day period specified in the regulations improperly extends the filing period. The court held that the statute allows a provider to file an application for fee review within the 30 days following a dispute notification or, alternatively, within the 90-day time period following the original billing date of treatment. Further, the court noted that a provider still has 30 days following the insurer’s notification of the denial of a resubmitted bill to file an application for fee review. The court found that the Bureau regulations involving fee review properly interpret and are consistent with the Act.

Case Law Alert, 2nd Qtr 2011