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Medical Treatment Review | Midpage
Collections
Pennsylvania Code
Title 34
Part VIII
Chapter 127
Medical Treatment Review
Medical Treatment Review
127.401
Purpose/review of medical treatment.
127.402
Treatment subject to review.
127.403
Assignment of cases to UROs by the Bureau.
127.404
Prospective, concurrent and retrospective review.
127.405
UR of medical treatment in medical only cases.
127.406
Scope of review of UROs.
127.407
Extent of review of medical records.
127.451
Requests for UR—who may file.
127.452
Requests for UR—filing and service.
127.453
Requests for UR—assignment by the Bureau.
127.454
Requests for UR—reassignment.
127.455
Requests for UR—conflicts of interest.
127.456
Requests for UR—withdrawal.
127.457
Time for requesting medical records.
127.458
Obtaining authorization to release medical records.
127.459
Obtaining medical records—provider under review.
127.460
Obtaining medical records—other treating providers.
127.461
Obtaining medical records—independent medical exams.
127.462
Obtaining medical records—duration of treatment.
127.463
Obtaining medical records—reimbursement of costs of provider.
127.464
Effect of failure of provider under review to supply records.
127.465
Requests for UR—deadline for URO determination.
127.466
Assignment of UR request to reviewer by URO.
127.467
Duties of reviewers—generally.
127.468
Duties of reviewers—conflict of interest.
127.469
Duties of reviewers—consultation with provider under review.
127.470
Duties of reviewers—issues reviewed.
127.471
Duties of reviewers—finality of decisions.
127.472
Duties of reviewers—content of reports.
127.473
Duties of reviewers—signature and verification.
127.474
Duties of reviewers—forwarding report and records to URO.
127.475
Duties of UROs—review of report.
127.476
Duties of UROs—form and service of determinations.
127.477
Payment for request for UR.
127.478
Record retention requirements for UROs.
127.479
Determination against insurer—payment of medical bills.
127.551
Petition for review by Bureau of UR determination.
127.552
Petition for review by Bureau—time for filing.
127.553
Petition for review by Bureau—notice of assignment andservice by Bureau.
127.554
Petition for Review by Bureau—no answer allowed.
127.555
Petition for review by Bureau—transmission of URO records to workers’ compensation judge.
127.556
Petition for Review by Bureau—de novo hearing.
127.601
Peer review—availability.
127.602
Peer review—procedure upon motion of party.
127.603
Peer review—interlocutory ruling.
127.604
Peer review—forwarding of request to Bureau.
127.605
Peer review—assignment by the Bureau.
127.606
Peer review—reassignment.
127.607
Peer review—conflicts of interest.
127.608
Peer review—withdrawal.
127.609
Obtaining medical records.
127.610
Obtaining medical records—independent medical exams.
127.611
Obtaining medical records—duration of treatment.
127.612
Effect of failure of provider under review to supply records.
127.613
Assignment of peer review request to reviewer by PRO.
127.614
Duties of reviewers—generally.
127.615
Duties of reviewers—conflict of interest.
127.616
Duties of reviewers—consultation with provider under review.
127.617
Duties of reviewers—issues reviewed.
127.618
Duties of reviewers—finality of decisions.
127.619
Duties of reviewers—content of reports.
127.620
Duties of reviewers—signature and verification.
127.621
Duties of reviewers—forwarding report and records to PRO.
127.622
Duties of PRO—review of report.
127.623
Peer review—deadline for PRO determination.
127.624
PRO reports—filing with judge and service.
127.625
Record retention requirements for PROs.
127.626
PRO reports—evidence.
127.627
PRO reports—payment.
127.651
Application.
127.652
Contents of an application to be authorized as a URO or PRO.
127.653
Decision on application.
127.654
Authorization periods.
127.655
Reauthorization.
127.656
General qualifications.
127.657
Local business office.
127.658
Accessibility.
127.659
Confidentiality.
127.660
Availability of reviewers.
127.661
Qualifications of reviewers.
127.662
Contracts with reviewers.
127.663
UR system.
127.664
Quality assurance system.
127.665
Case communication system.
127.666
Annual reports.
127.667
Compensation policy.
127.668
Suspension of assignments.
127.669
Revocation of authorizations.
127.670
Hearings.