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STATE COLLEGE MANOR LTD. v. COMMONWEALTH PENNSYLVANIA (09/25/85)

decided: September 25, 1985.

STATE COLLEGE MANOR LTD., PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



Appeal from the Order of the Office of Hearings and Appeals of the Department of Public Welfare, in case of Appeal of: Mr. Dale D. Pelton, Administrator, State College Manor, Ltd., dated January 17, 1984.

COUNSEL

Charles O. Barto, Jr., for petitioner.

William D. Lenahan, Assistant Counsel, for respondent.

Judges Doyle and Colins, and Senior Judge Barbieri, sitting as a panel of three. Opinion by Senior Judge Barbieri.

Author: Barbieri

[ 92 Pa. Commw. Page 90]

State College Manor (SCM) appeals here the order of the Department of Public Welfare's (DPW) Office of Hearings and Appeals adopting the recommendation of the hearing officer denying SCM's appeal from the decision of the Office of Medical

[ 92 Pa. Commw. Page 91]

Assistance which denied payment for medical assistance services rendered by SCM because correctly completed invoices were not submitted to the Department within 180 days of the date of service.

State College Manor is a facility which provides skilled and intermediate nursing care to approximately 173 patients. During the period from June, 1982 to December, 1982, SCM provided services to patients eligible under medicaid in the approximate amount of $85,000.00. Invoices for services rendered, some new and some resubmitted, were rejected and payment was denied as the invoices had not been submitted within the requisite 180 days from date of service.

Section 1101.68 of the Medical Assistance Manual, 55 Pa. Code ยง 1101.68, provides:

(a) Providers shall use the invoices specified by the Department or its agents when billing for Medical Assistance services or items. Providers shall submit the invoices within six months after the delivery of the services or items. Invoices that have not been completed according to specified instructions or that lack any required documentation will be rejected by the Department. In the event that an invoice is rejected by the Department, a remittance advice will be sent to the provider explaining the reason for the rejection. The provider may submit a correct invoice for payment.

(b) Any invoices submitted after the six-month period will be rejected absolutely unless:

(1) A recipient eligibility determination that was required to be made by a CAO was delayed ...


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