(a) A PRO shall return a request for peer review to the Bureau for reassignment if the following apply:
- (1) The PRO has a previous involvement with the patient or provider under review in the same matter.
- (2) The PRO has performed precertification functions in the same matter.
- (3) The PRO has provided case management services in the same matter.
- (4) The PRO has provided vocational rehabilitation services in the same matter.
- (5) The PRO is owned by or has a contractual relationship with any party subject to the review.
- (b) A PRO shall inform the reviewer assigned to perform peer review of the reviewer’s obligation to notify the PRO of any potential or realized conflicts arising under § 127.615 (relating to duties of reviewers—conflict of interest)