™Your Policy Risk Impact Agent
30 chapters · 793 sections in this title.
Va. Code Ann. § 32.1-137.16 Records
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Every entity subject to Article 1.1 (§ 32.1-137.1 et seq.) of Chapter 5 and this article shall maintain or cause to be maintained, in writing and at a location accessible to employees of the Department, records of review procedures; the health care qualifications of the entity's …
Va. Code Ann. § 32.1-137.17 Limitation on Commissioner's jurisdiction
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The Commissioner shall have the right to determine compliance with this article; however, the Commissioner shall have no jurisdiction to adjudicate individual controversies arising out of or incidental to this article.
Va. Code Ann. § 32.1-137.7 Definitions
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As used in this article: "Adverse determination" means a determination by the managed care health insurance plan or its designee utilization review entity that, based upon information provided, a request for a benefit upon application of any utilization review technique does not …
Va. Code Ann. § 32.1-137.8 Application to and compliance by utilization review entities
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A. No utilization review entity shall perform utilization review with regard to hospital, medical or other health care resources rendered or proposed to be rendered to a covered person except in accordance with the requirements and standards set forth in this article. B. This art…