§ 29. Definitions
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 77 P.S. Workers’ Compensation
77 P.S. § 29
§ 29. Definitions
In addition to the definitions set forth in this article, the following words and phrases when used in this act shall have the meanings given to them in this section unless the context clearly indicates otherwise:
“Adjudication” shall have the meaning given in 2 Pa.C.S. § 101 (relating to definitions).
“Bill” means a statement or invoice for payment of services under subsection (f.1) of section 3061 which identifies the claimant, the date of injury, the payment codes referred to in subsection (f.1) of section 306 and a description of the services provided on or in standard form prescribed by the Department of Labor and Industry.
“Burn facility” means a facility which meets the service standards of the American Burn Association.
“Commissioner” means the Insurance Commissioner of the Commonwealth.
“Coordinated care organization” or “CCO” means an organization licensed in Pennsylvania and certified by the Secretary of Labor and Industry on the basis of established criteria possessing the capacity to provide medical services to an injured worker.
“DRG” means diagnosis-related groups.
“HCFA” means the Health Care Financing Administration.
“Health care provider” means any person, corporation, facility or institution licensed or otherwise authorized by the Commonwealth to provide health care services, including, but not limited to, any physician, coordinated care organization, hospital, health care facility, dentist, nurse, optometrist, podiatrist, physical therapist, psychologist, chiropractor or pharmacist and an officer, employe or agent of such person acting in the course and scope of employment or agency related to health care services.
“Health maintenance organization” means an entity defined in and subject to the act of December 29, 1972 (P.L. 1701, No. 364), known as the “Health Maintenance Organization Act.”2
“Hospital plan corporation” means an entity defined in and subject to 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations).
“Insurance Company Law of 1921” means the act of May 17, 1921 (P.L. 682, No. 284), known as “The Insurance Company Law of 1921.”3
“Insurer” means an entity subject to the act of May 17, 1921 (P.L. 682, No. 284), known as “The Insurance Company Law of 1921,” including the State Workmen's Insurance Fund, with which an employer has insured liability under this act pursuant to section 3054 or a self-insured employer or fund exempted by the Department of Labor and Industry pursuant to section 305.
“Intermediary” means an organization with a contractual relationship with the Health Care Financing Administration to process Medicare Part A or Part B claims.
“Life-threatening injury” shall be as defined by the American College of Surgeons' triage guidelines regarding use of trauma centers for the region where the services are provided.
“Occupational Disease Act” means the act of June 21, 1939 (P.L. 566, No. 284), known as “The Pennsylvania Occupational Disease Act.”5
“Pass-through costs” means Medicare-reimbursed costs to a hospital that “pass through” the prospective payment system and are not included in the diagnosis-related group payments. The term includes medical education, capital expenditures, insurance and interest expense on fixed assets.
“Peer review,” for the purpose of undertaking reviews and reports pursuant to section 420,6 means review by:
“Professional health service corporation” means an entity defined in and subject to 40 Pa.C.S. Ch. 637 (relating to professional health services plan corporations).
“Provider” means a health care provider.
“Referee” means a workers' compensation judge, as designated under section 401.8
“Secretary” means the Secretary of Labor and Industry of the Commonwealth.
“Trauma center” means a facility accredited by the Pennsylvania Trauma Systems Foundation under the act of July 3, 1985 (P.L. 164, No. 45), known as the “Emergency Medical Services Act.”9
“Urgent injury” shall be as defined by the American College of Surgeons' triage guidelines regarding use of trauma centers for the region where the services are provided.
“Usual and customary charge” means the charge most often made by providers of similar training, experience and licensure for a specific treatment, accommodation, product or service in the geographic area where the treatment, accommodation, product or service is provided.
“Utilization review organizations” shall be those organizations consisting of an impartial physician, surgeon or other health care provider or a panel of such professionals and providers as authorized by the Secretary of Labor and Industry and published as a list in the form of a notice in the Pennsylvania Bulletin for the purpose of reviewing the reasonableness and necessity of treatment by a health care provider pursuant to section 306(f.1)(6).
Credits
1915, June 2, P.L. 736, No. 338, art. I, § 109, added 1993, July 2, P.L. 190, No. 44, § 3, effective in 60 days. Amended 1996, June 24, P.L. 350, No. 57, § 2, effective in 60 days.
Footnotes
77 P.S. § 531.
40 P.S. § 1551 et seq.
40 P.S. § 341 et seq.
77 P.S. § 501.
77 P.S. § 1201 et seq.
77 P.S. §§ 831, 832.
40 Pa.C.S.A. § 6301 et seq.
77 P.S. § 701.
35 P.S. § 6921 et seq. (repealed); see now, 35 Pa.C.S.A. § 8101 et seq.
77 P.S. § 29, PA ST 77 P.S. § 29
Current through Act 11 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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