Hospital of the University of Pennsylvania v. Bureau of Workers' Compensation (Tyson Shared Services, Inc.)

In Hospital of the University of Pennsylvania v. Bureau of Workers' Compensation (Tyson Shared Services, Inc.), 932 A.2d 1010 (Pa. Cmwlth. 2007), the Hospital of the University of Pennsylvania, Provider in this case as well, billed the insurance company in that case, Tyson Shared Services (TSS) on April 20, 2004, for medical treatment provided to the claimant in that case. Tyson, 932 A.2d at 1011. Provider did not give the claimant's medical records supporting the billing to TSS until July 23, 2004. Id. TSS sent payments to Provider on July 28, 2004 and September 1, 2004. Id. These payments amounted to only part of the total amount billed by Provider, and were accompanied by statements from TSS explaining that the amount of payment had been reduced because the amounts billed exceeded the amounts permitted under the Act. Id. On December 10, 2004, PRN, on Provider's behalf, requested the balance of the amount initially billed, explaining that the total amount was reimbursable under the Act. Id. Provider filed a claim appeal with TSS on January 26, 2005. "On September 27, 2005, Provider sent a letter to Insurer stating that Provider had not properly billed Insurer for Claimant's medical care. Provider then included medical records, reports and a LIBC-9 form." Id. Provider argued that because TSS was not obligated under the Act to render payment until the LIBC-9 Form was sent, then the 90-day time period should not begin to run until TSS received the form. The Bureau rejected this argument. The Court upheld the Bureau's determination on the ground that TSS had made partial payment to Provider, and it was not TSS's liability that was in question, but the amount of that liability. The Court also stated that: We reject Provider's contention that the statute of limitations cannot begin to run until a provider decides to perfect standing by completing its own paperwork. Nothing prevented Provider from submitting the proper paperwork to Insurer within the prescribed appeal period. Id. at 1014.