34 Pa. Code § 127.468. Duties of reviewers

34 Pa. Code § 127.468. Duties of reviewers—conflict of interest.

§ 127.468. Duties of reviewers—conflict of interest.

A reviewer shall return a review to the URO for assignment to another reviewer if one or more of the following exist:
   (1)  The reviewer has a previous involvement with the patient, or with the 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 §  127.455 (relating to requests for UR—conflicts of interest).

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