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Operational standards - 40 Pa. Stat. Ann. § 991.2152
Link to the law
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Current as of June 2015
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Utilization review entities must do the following:
- Protect the confidentiality of enrollee medical records;
- Conduct utilization reviews based on the medical necessity and appropriateness of the health care service being reviewed;
- Maintain a record of utilization review decisions adverse to enrollees for at least three years, including a detailed justification and all required notifications to the health care provider and the enrollee.
Current as of June 2015
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