provider claim (Pennsylvania) · Go Syfert
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provider claim in Pennsylvania

6 Pennsylvania opinions name it 3 courts 1986–2024 1 in the last five years

The cases below were cited by Pennsylvania courts in a sentence that names this issue. Sides come from how each citing opinion treated the case (Syfertize flag on that citation), so a case can appear on both: that is where the law is contested. A red or yellow chip is the case's own overall treatment.

Followed or applied (1)

CaseFollowedCited
Commonwealth v. Divine Providence Hospitalgreen
pacommwct · 1986 · cited in 1 Pennsylvania opinions naming this issue, 2005–2005
2 sentences

2005Seminally, in Department of Public Welfare v. Divine Providence Hospital, 101 Pa.Cmwlth. 248 , 516 A.2d 82 (1986), the Commonwealth Court rejected DPW’s position that a provider claim asserting that DPW breached its provider agreement by not reimbursing it in accordance with DPW regulations represented exclusively a non-contractual, regulatory dispute. 6 See id. at 252 , 516 A.2d at 84 (holding that the Board of Claims had jurisdiction because “this case ... concerns the question of whether DPW breached the provider agreement by not following its own regulations”). 7 In addition to advancing i

2005Seminally, in Department of Public Welfare v. Divine Providence Hospital, 101 Pa.Cmwlth. 248 , 516 A.2d 82 (1986), the Commonwealth Court rejected DPW’s position that a provider claim asserting that DPW breached its provider agreement by not reimbursing it in accordance with DPW regulations represented exclusively a non-contractual, regulatory dispute. 6 See id. at 252 , 516 A.2d at 84 (holding that the Board of Claims had jurisdiction because “this case ... concerns the question of whether DPW breached the provider agreement by not following its own regulations”). 7 In addition to advancing i

11

Distinguished, questioned or overruled (0)

CaseNegativeCited
No negative-treatment citations attached to this issue in Pennsylvania. Read the followed side critically anyway.

Also cited on this issue (8)

CaseCitedYears
Jiricko v. Geico Insurance green
pasuperct · 2008
1 sentence

2024Id.

12024–2024
Armour Pharmacy v. Bureau of WC Fee Review Hearing Office (Wegman's Food Markets, Inc.) green
pacommwct · 2019
1 sentence

2024Pa. R.C.P. 1028(7) allows a responding party to file preliminary objections when the filing party has failed "to exercise or exhaust a statutory remedy." The exclusive means by which a provider may challenge payment of a medical bill for 3 workers compensation related medical care is by the Pennsylvania Workers' Compensation Act Fee Dispute. 77 P.S. §531(5); Armour Pharmacy v. Bureau of Workers' Compensation Fee Review Hearing Office, 206 A.3d 660 (2019).

12024–2024
City of Philadelphia & Comp Services v. Medical Fee Review Office neutral
pacommwct · 1999
1 sentence

2019City of Philadelphia v. Medical Fee Review Office (RJS Industries), 737 A.2d 356 , 358 n.9 (Pa. Cmwlth. 1999). 7 injury, liability remains at issue, and, consequently, the Hearing Officer should have dismissed Provider’s hearing request for lack of jurisdiction.

12019–2019
Hospital of the University of Pennsylvania v. Bureau of Workers' Compensation green
pacommwct · 2007
1 sentence

2009In Hospital of the University of Pennsylvania v. Bureau of Workers’ Compensation (Tyson Shared Services, Inc.), 932 A.2d 1010 (Pa.Cmwlth.2007), appeal denied, 596 Pa. 735 , 945 A.2d 173 (2008), we held that a provider may not rely on its own non-compliance with the Act's reporting requirements to extend the time period to file a fee review application where, notwithstanding the provider’s non-compliance, the employer/insurer makes payment, and the only matter disputed is the amount paid. 8 .

12009–2009
Hospital of University of Pennsylvania v. Bureau of Workers'compensation neutral
pa · 2008
2 sentences

2009In Hospital of the University of Pennsylvania v. Bureau of Workers’ Compensation (Tyson Shared Services, Inc.), 932 A.2d 1010 (Pa.Cmwlth.2007), appeal denied, 596 Pa. 735 , 945 A.2d 173 (2008), we held that a provider may not rely on its own non-compliance with the Act's reporting requirements to extend the time period to file a fee review application where, notwithstanding the provider’s non-compliance, the employer/insurer makes payment, and the only matter disputed is the amount paid. 8 .

2009In Hospital of the University of Pennsylvania v. Bureau of Workers’ Compensation (Tyson Shared Services, Inc.), 932 A.2d 1010 (Pa.Cmwlth.2007), appeal denied, 596 Pa. 735 , 945 A.2d 173 (2008), we held that a provider may not rely on its own non-compliance with the Act's reporting requirements to extend the time period to file a fee review application where, notwithstanding the provider’s non-compliance, the employer/insurer makes payment, and the only matter disputed is the amount paid. 8 .

12009–2009
Klingerman Nursing Center, Inc. v. Commonwealth green
pacommwct · 1983
2 sentences

1986We recognize that this determination is inconsistent with statements made in Klingerman Nursing Center, Inc. v. Department of Public Welfare, 73 Pa. Commonwealth Ct. 470 , 458 A.2d 653 (1983) and Temple University—of the Commonwealth System of Higher Education v. Department of Public Welfare, 83 Pa. Commonwealth Ct. 516 , 480 A.2d 1267 (1984) and to the extent that Klingerman and Temple differ from our holding here they are specifically overruled.

1986We recognize that this determination is inconsistent with statements made in Klingerman Nursing Center, Inc. v. Department of Public Welfare, 73 Pa. Commonwealth Ct. 470 , 458 A.2d 653 (1983) and Temple University—of the Commonwealth System of Higher Education v. Department of Public Welfare, 83 Pa. Commonwealth Ct. 516 , 480 A.2d 1267 (1984) and to the extent that Klingerman and Temple differ from our holding here they are specifically overruled.

11986–1986
Temple University v. Commonwealth, Department of Public Welfare neutral
pacommwct · 1984
2 sentences

1986We recognize that this determination is inconsistent with statements made in Klingerman Nursing Center, Inc. v. Department of Public Welfare, 73 Pa. Commonwealth Ct. 470 , 458 A.2d 653 (1983) and Temple University—of the Commonwealth System of Higher Education v. Department of Public Welfare, 83 Pa. Commonwealth Ct. 516 , 480 A.2d 1267 (1984) and to the extent that Klingerman and Temple differ from our holding here they are specifically overruled.

1986We recognize that this determination is inconsistent with statements made in Klingerman Nursing Center, Inc. v. Department of Public Welfare, 73 Pa. Commonwealth Ct. 470 , 458 A.2d 653 (1983) and Temple University—of the Commonwealth System of Higher Education v. Department of Public Welfare, 83 Pa. Commonwealth Ct. 516 , 480 A.2d 1267 (1984) and to the extent that Klingerman and Temple differ from our holding here they are specifically overruled.

11986–1986
Commonwealth, Department of Public Welfare v. Forbes Health System green
pa · 1980
2 sentences

1986While it is true that in Department of Public Welfare v. Forbes Health System, 492 Pa. 77 , 422 A.2d 480 (1980), DPW adjudicated a provider claim, the issue which the Pennsylvania Supreme Court reviewed was “whether, under Medical Assistance regulations and the accompanying statutes, private independent physician groups which contract with hospitals to provide emergency room physician coverage are entitled to Medicaid reimbursement for services rendered to Medical Assistance patients while on emergency room duty, even though these hospitals receive Medicaid reimbursement for all emergency room

1986While it is true that in Department of Public Welfare v. Forbes Health System, 492 Pa. 77 , 422 A.2d 480 (1980), DPW adjudicated a provider claim, the issue which the Pennsylvania Supreme Court reviewed was “whether, under Medical Assistance regulations and the accompanying statutes, private independent physician groups which contract with hospitals to provide emergency room physician coverage are entitled to Medicaid reimbursement for services rendered to Medical Assistance patients while on emergency room duty, even though these hospitals receive Medicaid reimbursement for all emergency room

11986–1986

Where else courts name it

PA 6 (1986–2024) MA 2 (1988–2004) CA 2 (2014–2025) MI 2 (2017–2020)

Opinions by the citing court's state. A doctrine retained in one state and abandoned in another shows up here as a year span that stalls.

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