CODE OF VIRGINIA

STANDARDS FOR APPROVAL (§ 32.1-138.9)

Each private review agent shall file an application with the Department which
shall meet the following minimum standards and any additional standards
established by regulation pursuant to § 32.1-138.15, and pay a filing fee
established by the Department, in order to be approved by the Department:

   1.  A description of the procedures to be used in evaluating proposed or
   delivered hospital, medical, or other health care services;

   2.  The procedures by which patients or providers may seek reconsideration of
   determinations by private review agents;

   3.  The type and qualifications of the personnel either employed or under
   contract to perform the utilization review;

   4.  Procedures and policies which ensure that patient-specific medical records
   and information shall be kept strictly confidential except as authorized by
   the patient or by regulations adopted pursuant to this article; and

   5.  Assurances that reviewers be readily accessible by telephone to patients
   and providers at least forty hours per week during normal business hours.

HISTORY: 1990, c. 826, § 38.2-5302; 1998, c. 129.