Section 127.259. Fee review hearing

(a) The Bureau will assign the request for a hearing to a hearing officer who will schedule a de novo proceeding. All parties will receive reasonable notice of the hearing date, time and place.

(b) The hearing will be conducted in a manner to provide all parties the opportunity to be heard. The hearing officer will not be bound by strict rules of evidence. All relevant evidence of reasonably probative value may be received into evidence. Reasonable examination and cross-examination of witnesses will be permitted.

(c) The parties may be represented by legal counsel, but legal representation at the hearing is not required.

(d) Testimony will be recorded and a full record kept of the proceeding.

(e) All parties will be provided the opportunity to submit briefs addressing issues raised.

(f) The insurer shall have the burden of proving by a preponderance of the evidence that it properly reimbursed the provider.

Notation

Cross References

This section cited in 34 Pa. Code § 127.302 (relating to resolution of self-referral disputes by Bureau).