§ 122.623. Data reporting requirements.
(a) A CCO shall file an annual report with the Department for each 12 months of operation. This report shall be filed with the Department within 60 days after the end of each 12-month period and shall summarize the CCO’s activities during the preceding 12-month period and include the following:
(1) The number of self-insured employers which had offered the CCO to injured workers during the reporting period as one of the specified providers under section 306(f.1)(1)(i) of the act (77 P. S. § 531.1(1)(i)).
(2) The number of workers’ compensation insurers which had offered the CCO during the reporting period as one of the specified providers under section 306(f.1)(1)(i) of the act.
(3) The total number of workers eligible to utilize the CCO during the reporting period.
(4) The number of workers who actually utilized the CCO during the reporting period and the length of time of the utilization.
(5) The number of each of the following for the reporting period: complaints and grievances filed, resolved in favor of the injured worker, decided in favor of the CCO or participating coordinated care provider, pending resolution and appealed by injured workers to the Department.
(6) The number of each of the following for the reporting period: utilization review decisions appealed by participating coordinated care providers, settled in favor of the provider, settled in favor of the CCO and pending resolution.
(7) The number of injured workers during the reporting period who initially selected the CCO and were still under treatment 31 days after the injury and receiving care through the CCO, and who initially selected the CCO and were still under treatment 31 days after the injury and who exercised their option to seek continued treatment from non-CCO providers.
(8) The number of injured workers during the reporting period who selected the CCO option who returned to work within: 0—7 days; 8—14 days; 15—30 days; 31—40 days; 41—50 days; 51—60 days; 61—365 days; or more than 365 days after injury.
(9) The number of workers during the reporting period who were reinjured or requiring medical services relating to the original injury within: 0—7 days; 8—30 days; 31—90 days; 91—365 days of their return to work.
(10) The record of timeliness of delivery of services during the reporting period, as required by § 122.609(d) (relating to requirements for a CCO’s health service delivery system).
(11) The cost of providing services to injured workers, for the reporting period, in a form and with specificity the Department may require.
(b) The Department may require uniform collection of data as to data required by this section or to track specific diagnoses related to the treatment of injured workers, and to require the production of the data for standardized time periods to facilitate the Department’s compilation of statistics to compare CCO performance.
Cross References This section cited in 34 Pa. Code § 122.627 (relating to changes or additions to previously approved application).
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