34 Pa. Code § 127.455 - Initial requests for UR-conflicts of interest
(a) A URO shall be deemed to have a conflict
of interest and shall return a request for UR to the Bureau for reassignment if
one or more of the following exist:
(1) The
URO has a previous involvement with the patient or with the provider under
review, regarding the same underlying claim.
(2) The URO has performed precertification
functions in the same matter.
(3)
The URO has provided case management services in the same matter.
(4) The URO has provided vocational
rehabilitation services in the same matter.
(5) The URO is owned by or has a contractual
arrangement with any party subject to the review.
(b) A URO shall inform the reviewer assigned
to perform UR of the reviewer's obligation to notify the URO of any potential
or realized conflicts arising under §
127.468 (relating to duties of
reviewers-conflict of interest).
Notes
This section cited in 34 Pa. Code § 127.454 (relating to initial requests for UR-reassignment).
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