Pennsylvania Statutes Title 40 P.S. Insurance § 991.2131. Confidentiality

(i) Prevent disclosure necessary to determine coverage, review complaints, grievances or adverse benefit determinations, conduct utilization review or facilitate payment of a claim.

(ii) Deny the department or the Department of Human Services access to records for purposes of quality assurance, investigation of complaints, grievances or adverse benefit determinations, enforcement or other activities related to compliance with this article and other laws of this Commonwealth. Records shall be accessible only to department employes or agents with direct responsibilities under the provisions of this subparagraph.

(iii) Deny access to information necessary for a utilization review entity to conduct a review under this article.

(iv) Deny access to the insurer or MA or CHIP managed care plan for internal quality review, including reviews conducted as part of the insurer's or MA or CHIP managed care plan's quality oversight process. During such reviews, covered persons and enrollees shall remain anonymous to the greatest extent possible.

(v) Deny access to insurers or MA or CHIP managed care plans, health care providers and their respective designees for the purpose of providing patient care management, outcomes improvement and research. For this purpose, covered persons and enrollees shall provide consent and shall remain anonymous to the greatest extent possible.