Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1032 (February 24, 2024).

55 Pa. Code § 1101.72. Invoice adjustment.

§ 1101.72. Invoice adjustment.

 The Bureau of Utilization Review on a prepayment review may either reject invoices or adjust invoices downward to eliminate noncompensable items or items that are not medically necessary. Also, future invoices may be adjusted downward to correct previous overpayments discovered through postpayment invoice review.

Cross References

   This section cited in 55 Pa. Code §  5221.43 (relating to quality assurance and utilization review).

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