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Coordinated Care Organizations—Statementof Policy | Midpage
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Pennsylvania Code
Title 34
Part VIII
Chapter 122
Coordinated Care Organizations—Statementof Policy
Coordinated Care Organizations—Statementof Policy
122.601
Applicability and purpose.
122.602
Definitions.
122.603
Uncertified CCOs.
122.604
Application process.
122.605
Certification application fees.
122.606
Certification periods.
122.607
Recertification.
122.608
Contents of an application for certification as a CCO.
122.609
Requirements for a CCO’s health service delivery system.
122.610
Standards for contracts and agreements with providers.
122.611
Standards for a case management and evaluation system and case communication system.
122.612
Standards for utilization review.
122.613
Standards for quality assurance program.
122.614
Injured worker satisfaction program.
122.615
Injured worker grievance system and provision of alternatives.
122.616
External quality assessment of CCOs.
122.617
Corrective action plans.
122.618
Exemptions for rural CCOs.
122.619
Access to records; inspections of CCOs.
122.620
Role of the CCO in billing.
122.621
Referrals within a CCO.
122.622
Prohibition of risk-transfer to CCOs.
122.623
Data reporting requirements.
122.624
Requirements for service area expansion.
122.625
Injured worker literature.
122.626
Contracts with independent organizations for performance of case management and communication or utilization review services.
122.627
Changes or additions to previously approved application.