Pennsylvania Statutes Title 40 P.S. Insurance § 991.2151. Certification

(a) A utilization review entity may not review health care services delivered or proposed to be delivered in this Commonwealth unless the entity is certified by the department to perform utilization review.

(b) The department may grant certification to a utilization review entity that meets the requirements of this section. Certification shall be renewed every three years unless otherwise subject to additional review, suspension or revocation by the department.

(c) The department may adopt a nationally recognized accrediting body's standards to certify utilization review entities to the extent the standards meet or exceed the standards set forth in this article.

(d) The department may prescribe application and renewal fees for certification. The fees shall reflect the administrative costs of certification.

(e) An insurer or MA or CHIP managed care plan with a certificate of authority shall comply with the standards and procedures of this subdivision but shall not be required to obtain separate certification as a utilization review entity.