Managed Care

The Department of Health reviews, approves, licenses and monitors the quality of care provided to consumers by health maintenance organizations (HMOs) and other managed care systems.  The Department promotes innovation in the health care marketplace by encouraging the development of alternative health delivery systems.  It identifies problems associated with cost, quality and access within the managed care industry and initiates solutions with consumers and providers.

The Department also administers a consumer grievance program and ensures that each licensed HMO has an approved process in place to handle member complaints and grievances.  When an HMO member is dissatisfied with the way their insurer has handled their complaint or grievance, a toll-free number, answered by Department of Health staff is available to provide additional information and/or assist them in obtaining resolution.

For more information, please contact us Monday through Friday 8 a.m. to 5 p.m. at one of the numbers below:
(717) 787-5193 or toll-free 1-888-466-2787

Or by writing:

Pennsylvania Department of Health
Bureau of Managed Care
Room 912 Health & Welfare Building
 625 Forster Street
Harrisburg, Pennsylvania 17120-0701

 

Managed Care Reporting Instructions and Templates

Managed Care Reports

Managed Care Regulations

CRE Application

PPO Application

Technical Advisories