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Pennsylvania Utilization Review Determination Face Sheet

Pennsylvania Utilization Review Determination Face Sheet

Name: Pennsylvania Utilization Review Determination Face Sheet
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.79 (241 reviews)

Category:

Pennsylvania Workers Compensation - Official

State:

Pennsylvania

Control #:

PA-SKU-4569

Format:

Instant download

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Public form

Description

Utilization Review Determination Face Sheet The Pennsylvania Utilization Review Determination Face Sheet is a document used by health insurance providers in Pennsylvania to review and determine the medical necessity of health care services. It is used to determine if a health care service is medically necessary and should be covered by insurance. The Face Sheet includes information about the patient, the requesting provider, the requested service, and the determination of medical necessity. There are two types of Pennsylvania Utilization Review Determination Face Sheets: Medical Necessity Determination Face Sheet and Non-Medical Necessity Determination Face Sheet. The Medical Necessity Determination Face Sheet is used when the requested service is considered medically necessary. The Non-Medical Necessity Determination Face Sheet is used when the requested service is not considered medically necessary.

The Pennsylvania Utilization Review Determination Face Sheet is a document used by health insurance providers in Pennsylvania to review and determine the medical necessity of health care services. It is used to determine if a health care service is medically necessary and should be covered by insurance. The Face Sheet includes information about the patient, the requesting provider, the requested service, and the determination of medical necessity. There are two types of Pennsylvania Utilization Review Determination Face Sheets: Medical Necessity Determination Face Sheet and Non-Medical Necessity Determination Face Sheet. The Medical Necessity Determination Face Sheet is used when the requested service is considered medically necessary. The Non-Medical Necessity Determination Face Sheet is used when the requested service is not considered medically necessary.

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FAQ

The Pennsylvania Workers' Compensation Act provides wage loss and medical benefits to compensate employees suffering from work- related injuries or diseases. The Act also provides for death benefits to the dependents of workers who die as a result of a work-related injury or disease.

The Employer's Assessment Fee Is 0.0289 (2.89%)

The proposed employer assessment factor is 0.0318. This factor, in concert with the proposed employer assessment procedure, is subject to approval by the Insurance Commissioner.

The maximum amount of wage loss benefits is based on the Department of Labor and Industry's calculation of the statewide average weekly wage. For the calendar year 2023 the maximum weekly compensation rate is $1,273.00. This amount only applies if you sustain a work-related injury in 2023 that results in wage loss.

The utilization review process provides for the impartial review of the reasonableness or necessity of medical treatment rendered to, or proposed for, work-related injuries and illnesses.

Workers' Compensation is tax-free. In Pennsylvania, the weekly compensation rate amounts to 66% of the injured worker's average weekly wage if they earned between $810.76 and $1,621.50 prior to the injury. For workers who earn between $600.56 and $810.75, the weekly compensation rate is $540.50.

Under the Pennsylvania Workers' Compensation Act, injured workers are entitled to wage loss (?indemnity benefits?) based on the earnings at the time of injury. Generally speaking, indemnity benefits are calculated based on two-thirds (2/3) of your average weekly wage (?AWW?).

Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

More info

Utilization Review Determination Face Sheet Form. This is a Pennsylvania form and can be use in Workers Comp.The utilization review (UR) process compares requests for medical services to appropriate evidence-based treatment guidelines and includes a recommendation. The Utilization Review Nurse then prints an updated Face Sheet for the patient and faxes this face sheet to DAS Collection Services. Learn about the review processes in utilization management, who it involves, the pros and cons, and how to get started. Utilization Review (UR) is the evaluation of medical care services for the treatment provided to an injured worker. Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks. Why do we care about patient status, documentation, and complying with recommended guidelines? Dental plan organization for whom the applicant is performing utilization review in Maryland. Why do we care about patient status, documentation, and complying with recommended guidelines?

Pennsylvania Utilization Review Determination Face Sheet

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