PROVIDER NETWORK RULES for PENNSYLVANIA

Provider Selection
Employer/insurer may direct for the first 90 days of treatment after the first visit, by use of a panel posting. If there is no list, the employee can select the treating provider.

Provider Lists
Provider lists and directories may be utilized. There is a state-mandated posting (Panel).

  1. The panel must include at least six designated providers. Four may be coordinated care organizations (CCO) or hospitals/facilities, and no fewer than three must be physicians.
  2. The list must include the specialty of the provider.
  3. If the list includes a CCO, the employer may not individually list any provider participating in that CCO if those individually listed providers are bound by the terms of the CCO for treatment.
  4. Employer must provider written notice to all injured employees of their rights.