Pennsylvania Code
Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

• No statutes or acts will be found at this website.

The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 488 (January 27, 2024).

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.


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.