External Review Process for Plans and Issuers Not Subject to Act 68 of 1998
The Pennsylvania Department of Health, Bureau of Managed Care (BMC) is making its external review process available to all Plans and Issuers not covered by Act 68 but required by federal law to have an external review process available for Enrollees as of September 23, 2010.
The Department’s Tool Kit provides information which will guide Plans and Issuers through both the Standard and the Expedited external review process including timeframes, a helpful “3 Step Process Guide” providing assistance in making an assignment request and general information about the Standard, Expedited, and Provider Initiated external review processes.
If you have any questions, please contact us at (717) 787-5193 or toll-free at (888) 466-2787.
External Review Process Presentation
Plans and Issuers who elect to use the external review process please submit both a Registration Form and a Conflict of Interest Form.
Bureau of Managed Care
Pennsylvania Department of Health
Room 912 Health & Welfare Building
625 Forster Street
Harrisburg, Pennsylvania 17120-0701
Consumer Helpline (888) 466-2787
Fax (717) 705-0947