6 Pa. Code § 22.81 - Utilization control
(a) Enrolled
providers are required, upon request, to furnish the Department with medical
and fiscal records relating to participation in PACE. Providers shall fully
cooperate with audits and reviews made by the Department for the purpose of
determining the validity of claims and the reasonableness and necessity of
benefits provided or for another purpose.
(b) Providers shall furnish to the
Department, within 15-calendar days of request, complete information related to
PACE-related business transactions.
(c) Under §
22.84 (relating to administrative
actions and penalties), failure of a provider to comply with the Department's
request for information referred to in this section may result in the
termination of a provider's enrollment in the PACE Program.
(d) Enrolled providers shall respond in a
complete manner to inquiries by utilization review committees within 7 business
days of a committee's request.
Notes
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