CODE OF VIRGINIA

HEALTH CARRIER’S INTERNAL APPEAL PROCESS (§ 38.2-3558)

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.

HISTORY: 2011, c. 788.