Appeal from the Order of the Board of Claims in the case of Joseph I. F. Jerrytone, D.M.D. v. Commonwealth of Pennsylvania, Department of Public Welfare, Docket No. FC-348-84.
Bruce G. Baron, Assistant Counsel, for petitioner.
Jerome L. Cohen, for respondent.
Judges Doyle, Palladino and Smith, sitting as a panel of three. Opinion by Judge Doyle.
[ 118 Pa. Commw. Page 475]
This is an appeal by the Department of Public Welfare (DPW) from an order of the Board of Claims (Board) which ordered that DPW pay to Joseph I. F. Jerrytone, D.M.D., the amount of $9,780 together with interest at the rate of six percent per annum beginning from March 27, 1984. In so doing the Board granted to Dr. Jerrytone, a provider of dental services under an agreement with DPW, payment for certain services rendered, but denied payment as to other services. Dr. Jerrytone has not cross-appealed as to those payments which the Board denied him.
The Board found that Dr. Jerrytone had been a provider of services since 1974. Dr. Jerrytone had submitted invoices weekly or bi-weekly to DPW. Prior to rendering the services, Dr. Jerrytone also verified each patient's eligibility. The Board also found that the pertinent
[ 118 Pa. Commw. Page 476]
DPW regulation provides that an original invoice for payment must be submitted to DPW within six months from the date the service is rendered and that a rejected invoice may be resubmitted within an extended six-month period.
Prior to 1979, Dr. Jerrytone submitted invoices and received reimbursement with little difficulty. At that time DPW made extensive changes in billing and payment procedures and implemented a complex computer system. These changes resulted in the return by DPW of various invoices and their later resubmissions were then deemed untimely under DPW Regulation 1101.68, 55 Pa. Code § 1101.68. On December 15, 1982 Dr. Jerrytone submitted 255 invoices for review by DPW's Claim Division. Review was denied. Thereafter, Dr. Jerrytone, upon the advice of DPW, contacted the Board and submitted to it the 255 invoices with a cover letter. Exactly when DPW advised Dr. Jerrytone to go to the Board and precisely what advice it gave him and who gave it are facts not indicated in the Board's adjudication. But obviously the advice was given sometime between the December 15, 1982 denial of review and May 2, 1983, on which date the Board accepted Dr. Jerrytone's documents as the filing of a claim. The Board, by letter dated May 10, 1983, communicated with Dr. Jerrytone as follows:
On behalf of the Board of Claims, I acknowledge receipt of your letter of transmittal, as well as supporting documentation concerning your inability to resolve a claim with the Department of Public Welfare in the sum of $18,556.00.
This Board is a quasi-judicial tribunal which is governed by the Pennsylvania Rules of Civil Procedure, in accordance with the statutory authority contained in Act ...