Pennsylvania's

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.

Letter and Forms

Extention of Safe Harbor (Non Act 68)

External Review

Registration Form

Conflict of Interest Form

Tool Kit

3 Step Process Guide

Standard External Review Fact Sheet

Expedited External Review Fact Sheet

Provider Initiated External Review Fact Sheet

External Review Process Presentation