34 Pa. Code § 127.615. Duties of reviewers

34 Pa. Code § 127.615. Duties of reviewers—conflict of interest.

§ 127.615. Duties of reviewers—conflict of interest.

A reviewer shall return a review to the PRO for assignment to another reviewer if one or more of the following exist:
   (1)  The reviewer has a previous involvement with the patient or provider under review regarding the same matter.
   (2)  The reviewer has performed precertification functions in the same matter.
   (3)  The reviewer has provided case management services in the same matter.
   (4)  The reviewer has provided vocational rehabilitation services in the same matter.
   (5)  The reviewer has a contractual relationship with any party in the matter.

Cross References

   This section cited in 34 Pa. Code §  127.607 (relating to peer review—conflicts of interest).

No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.