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Plan reporting requirements - 28 Pa. Code § 9.604

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A plan must annually submit to the department of health a detailed report of its activities, including the following provisions: 

  • Utilization statistics on a quarterly, year-to-date and annualized basis containing the number of days of inpatient hospitalization and the average number of physician visits per enrollee;
  • The number, type and disposition of all complaints and grievances; and
  • A copy of the plan’s quality assurance program, its quality assurance work plan, and the quality assurance report submitted to its board of directors.

Current as of June 2015