Pennsylvania Statutes Title 40 P.S. Insurance § 991.2153. Provider portal

(1) Electronic submission of prior authorization requests.

(2) Access to the insurer's or MA or CHIP managed care plan's applicable medical policies.

(3) Information necessary to request a peer-to-peer review.

(4) Contact information for the insurer's or MA or CHIP managed care plan's relevant clinical or administrative staff.

(5) For any health care service that requires prior authorization that is not subject to electronic submission via the provider portal, copies of applicable submission forms.

(6) Instructions for the submission of prior authorization requests if the insurer's or MA or CHIP managed care plan's provider portal is unavailable for any reason.

(1) Within 18 months following the establishment of a provider portal under subsection (a), a health care provider seeking prior authorization shall submit the request via an insurer's or MA or CHIP managed care plan's provider portal unless an exception applies.

(2) An insurer or MA or CHIP managed care plan may require a health care provider to submit a prior authorization request through the provider portal unless any of the following exceptions applies: