Each health carrier shall establish an internal appeal process, including a process for urgent care appeals, to consider a utilization review adverse determination or other adverse benefit determination or decision that is appealed by a covered person, his authorized representative, or his provider. The Commission shall promulgate regulations effectuating the purpose of this section, including timeframes for filing appeals, types of claims that may be appealed including rescissions, notice requirements, rights of the covered person, and reviewer requirements.
2011, c. 788.
Structure Code of Virginia
Chapter 35.1 - Health Carrier Internal Appeal Process and External Review
§ 38.2-3558. Health carrier's internal appeal process
§ 38.2-3559. Notice of right to external review
§ 38.2-3560. Exhaustion of internal appeal process
§ 38.2-3561. Standard external review
§ 38.2-3562. Expedited external review
§ 38.2-3563. External review of experimental or investigational treatment adverse determinations
§ 38.2-3564. Binding nature of external review decision
§ 38.2-3565. Minimum qualifications for independent review organizations
§ 38.2-3566. Approval of independent review organizations
§ 38.2-3567. Independent review organizations to be held harmless
§ 38.2-3568. External review reporting requirements
§ 38.2-3569. Funding of external review