14VAC5-216 Rules Governing Internal Appeal and External Review

REGULATIONS

Vol. 30 Iss. 24 - July 28, 2014

TITLE 14. INSURANCE

STATE CORPORATION COMMISSION

Chapter 216

Forms

NOTICE: Forms used in administering the following regulation have been filed by the State Corporation Commission. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of the new or amended form to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.

Title of Regulation: 14VAC5-216. Rules Governing Internal Appeal and External Review.

Effective Date: July 28, 2014.

Agency Contact: Robert Grissom, Chief Insurance Market Examiner, Bureau of Insurance, State Corporation Commission, P.O. Box 1157, Richmond, VA 23218, telephone [phone] or email [e-mail].

FORMS (14VAC5-216)

External Review Request Form, Form 216-A (7/11)

Appointment of Authorized Representative, Form 216-B (7/11)

Physician Certification Expedited External Review Request, Form 216-C (7/11)

Physician Certification Experimental or Investigational Denials, Form 216-D (7/11)

Independent Review Organization Application for Registration, Form 216-E (7/11)

Independent Review Organization Application for Registration, Form 216-E (rev. 7/14)

Health Carrier External Review Annual Report Form, Form 216-F (7/11)

Independent Review Organization External Review Annual Report Form, Form 216-G (7/11)

Self-Insured Plan Opt-In to Virginia External Review Process, Form 216-H (7/11)

VA.R. Doc. No. R14-4105; Filed July 2, 2014, 3:32 p.m.