Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter B - HOSPITALS AND HOSPITAL UNITS UNDER COST REIMBURSEMENT PRINCIPLES
RIGHT OF APPEAL
Section 1163.501 - Provider right to appeal
Universal Citation: 55 PA Code ยง 1163.501
Current through Register Vol. 54, No. 44, November 2, 2024
(a) The hospital's right of appeal is under Chapter 1101 (relating to general provisions).
(b) Hospitals and practitioners do not have the right to a separate appeal on the same inpatient case. For purposes of this chapter, inpatient services are considered to be those services provided by hospital personnel. Practitioner appeals relating to inpatient services are expected to be resolved through the utilization review process.
(c) For cases undergoing the appeal process, payment, including adjustments, will be withheld until the case is adjudicated.
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