What the panel ordered
Petition for Reconsideration denied.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
Most of the services in contention were for items not included in the OMFS, so DTC had the burden to establish reasonable charges and did not show EOBs were late or request secondary review. Defendant provided EOBs with reasons for payment amounts. DTC did not contest the allowed amount, only the lack of interest or penalty.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Most of DTC's services were for items not included in the OMFS, so DTC had to establish reasonable charges.
Favours Defendant prevailed
Without OMFS coverage, DTC bore the burden to prove reasonableness and did not do so.
Defendant produced EOBs for DTC's dates of service and advised of allowed amounts and reasons; DTC did not show EOBs were late or request secondary review.
Favours Defendant prevailed