Pennsylvania requires individuals to submit a Utilization Review Request when they are seeking coverage for healthcare services that are not typically covered by their insurance plan. The Utilization Review Request must be completed and submitted to the insurance company for review and approval. The Pennsylvania instructions for Completing Utilization Review Request include: 1. Identifying the patient: In the Utilization Review Request, the patient must provide their name, address, date of birth, insurance plan information, and contact information. 2. Identifying the provider: The patient must also provide the name, address, and contact information of the provider who will be providing the services. 3. Describing the services: The patient must provide a detailed description of the services they are requesting coverage for. This should include the diagnosis or condition that the services are being requested for, the type of services being requested, the frequency of the services, and the expected duration of the services. 4. Requesting pre-authorization: The patient must include a request for pre-authorization for the services. This request should include any additional information that the insurance company may need to make a decision on the request. 5. Submitting the form: The Utilization Review Request must be signed and dated by the patient and submitted to the insurance company for review. These are the Pennsylvania instructions for Completing Utilization Review Request. Following these instructions will help ensure that the request is processed quickly and accurately.