The Pennsylvania Petition for Review of Utilization Review Determination is a formal request by a patient or their representative to the Health Care Cost Containment Council (HC3) to review a utilization review determination made by an insurer. The purpose of the review is to determine if the insurer’s decision was appropriate according to state and federal laws. The petition must be filed within 60 days of the date of the utilization review determination. There are two types of Pennsylvania Petition for Review of Utilization Review Determination: Formal and Informal. The formal petition requires the submission of a detailed description of the dispute and must include supporting documentation. The informal petition is a less formal request and does not require the submission of supporting documentation. Both types of petitions must include the name of the insurer, the policy number, the date of the utilization review determination, the reason for the dispute, and the signature of the petitioner or their representative.
The Pennsylvania Petition for Review of Utilization Review Determination is a formal request by a patient or their representative to the Health Care Cost Containment Council (HC3) to review a utilization review determination made by an insurer. The purpose of the review is to determine if the insurer’s decision was appropriate according to state and federal laws. The petition must be filed within 60 days of the date of the utilization review determination. There are two types of Pennsylvania Petition for Review of Utilization Review Determination: Formal and Informal. The formal petition requires the submission of a detailed description of the dispute and must include supporting documentation. The informal petition is a less formal request and does not require the submission of supporting documentation. Both types of petitions must include the name of the insurer, the policy number, the date of the utilization review determination, the reason for the dispute, and the signature of the petitioner or their representative.
