34 Pa. Code § 127.455

Current through Register Vol. 50, No. 49, December 5, 2020
Section 127.455 - Initial requests for UR-conflicts of interest
(a) A URO shall be deemed to have a conflict of interest and shall return a request for UR to the Bureau for reassignment if one or more of the following exist:
(1) The URO has a previous involvement with the patient or with the provider under review, regarding the same underlying claim.
(2) The URO has performed precertification functions in the same matter.
(3) The URO has provided case management services in the same matter.
(4) The URO has provided vocational rehabilitation services in the same matter.
(5) The URO is owned by or has a contractual arrangement with any party subject to the review.
(b) A URO shall inform the reviewer assigned to perform UR of the reviewer's obligation to notify the URO of any potential or realized conflicts arising under § 127.468 (relating to duties of reviewers-conflict of interest).

34 Pa. Code § 127.455