Managed Care 2010 Health Plan Utilization Review Audit

The Pennsylvania Department of Health, Bureau of Managed Care (the Bureau), is undertaking an audit of the utilization review (UR) practices of managed care plans, including UR activity by subcontractors. The purpose of this audit is to assure the managed care plans' compliance with the UR standards established under the Quality Health Care Accountability and Protection Act, commonly referred to as Act 68, and the Department's Managed Care Regulations.  

Due Date:  February 8, 2010

Please click the links below to open the instructions and the working forms

Instructions                                 Forms

Submission Notes:

* Spreadsheets must be completed and submitted electronically

* Authorization or case file numbers must be included, where indicated