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COMMONWEALTH OF PENNSYLVANIA

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55 Pa. Code § 1245.71. Scope of claims review procedures.

UTILIZATION CONTROL


§ 1245.71. Scope of claims review procedures.

 Claims submitted for payment under the MA Program are subject to the utilization control procedures established in Chapter 1101 (relating to general provisions). Providers shall fully cooperate with audits and reviews made by the Department for the purpose of determining the validity and claims, the reasonableness and necessity of services provided and charges made to the general public.

Source

   The provisions of this §  1245.71 adopted October 31, 1980, effective November 1, 1980, 10 Pa.B. 4257.


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