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Certified Review Entity (CRE) Application
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Any entity intending to perform utilization review on behalf of managed care plans and/or to conduct external grievance appeal reviews must be certified as a utilization review entity by the Department of Health, in accordance with the provisions of Act 68 Managed Care regulations (40 P.S. §9912101, et seq.) and the Department of Health's managed care regulations (28 Pa. Code, Chapter 9, Subchapters K and I).
To become certified, an entity must complete and submit an application to the Department for review and approval. Upon approval, the CRE will be granted a three-year certification. Certification must be renewed every three years, with a renewal application submitted to the Department at least 60 days prior to the expiration of a CRE's certification period.
The application below is to be completed for both initial certifications and renewals of certifications.
Note: Please do not use previous applications as the application on-line is updated and revised on regular basis. |
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