A. No accident and sickness insurer, health maintenance organization, health services plan, or optometric services plan licensed in the Commonwealth shall refuse to accept, as a standard claims form for physician services or for services provided by chiropractors, optometrists, opticians, professional counselors, psychologists, clinical social workers, podiatrists, physical therapists, clinical nurse specialists who render mental health services, audiologists, and speech pathologists, the standardized HCFA-1500 health insurance claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an insurer, health maintenance organization, health services plan, or optometric services plan from accepting any other claims form.
B. No accident and sickness insurer, health maintenance organization, or health services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for hospital services the standardized UB-82 claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, or health services plan from accepting any other claims form.
C. No accident and sickness insurer, health maintenance organization, health services plan, or dental services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for dental services the standardized ADA form prepared by the American Dental Association, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, health services plan, or dental services plan from accepting any other claims form.
D. The forms specified in this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means.
E. After July 1, 1998, no health maintenance organization authorized to transact business in this Commonwealth and no health insurer, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth that requires the use of the Physicians' Current Procedural Terminology (CPT) identifying codes published by the American Medical Association for reporting claims for medical services and procedures, including any standardized form, shall refuse to accept and utilize these identifying codes and any appropriate modifiers listed therein when the same are appropriately used for processing such claims for provider services and procedures.
1993, c. 307; 1997, c. 531.
Structure Code of Virginia
Chapter 3 - Provisions Relating to Insurance Policies and Contracts
§ 38.2-301. Insurable interest required; life, accident and sickness insurance
§ 38.2-302. Life, accident, and sickness insurance; application required
§ 38.2-303. Insurable interest required; property insurance
§ 38.2-304. Contracts of temporary insurance; duration; what deemed to include
§ 38.2-305. Contents of policies
§ 38.2-306. Additional contents
§ 38.2-307. Charter and bylaw provisions in policies
§ 38.2-308. Contingent liability provisions in policies issued by certain mutual insurers
§ 38.2-309. When answers or statements of applicant do not bar recovery on policy
§ 38.2-310. All fees, charges, etc., to be stated in policy
§ 38.2-311. Type size in which conditions and restrictions to be printed
§ 38.2-313. Where certain contracts deemed made
§ 38.2-314. Limitation of action and proof of loss
§ 38.2-315. Intervening breach
§ 38.2-316. Policy forms to be filed with Commission; notice of approval or disapproval; exceptions
§ 38.2-317. Delivery and use of certain policies and endorsements
§ 38.2-318. Validity of noncomplying forms
§ 38.2-319. Validity of contracts in violation of law
§ 38.2-320. Insurer to furnish forms for proof of loss
§ 38.2-321. Payment discharges insurer
§ 38.2-322. Standardized claims forms
§ 38.2-324. Disclosure of property damage information