TITLE 14. INSURANCE
REGISTRAR'S NOTICE:
Forms used in administering the regulation have been filed by the agency. The
forms are not being published; however, online users of this issue of the
Virginia Register of Regulations may click on the name of a form with a hyperlink
to access it. The form is also available from the agency contact or may be
viewed at the Office of the Registrar of Regulations, 900 East Main Street,
11th Floor, Richmond, Virginia 23219.
Title of Regulation: 14VAC5-216. Rules Governing
Internal Appeal and External Review.
Agency Contact: Kim Naoroz, Principal Insurance Market
Examiner, State Corporation Commission, Bureau of Insurance, P.O. Box 1157,
Richmond, VA 23218, telephone (804) 371-9913, FAX (804) 371-9944, or email kim.naoroz.scc.virginia.gov.
FORMS (14VAC5-216)
External Review Request Form, Form 216-A (eff. 7/11)
External
Review Request Form, Form 216-A (rev 4/2019)
Appointment of Authorized Representative, Form
216-B (eff. 7/2011)
Physician Certification Expedited External Review
Request, Form 216-C (eff. 7/2011)
Physician Certification Experimental or
Investigational Denials, Form 216-D (eff. 7/2011)
Independent Review Organization Application for
Registration, Form 216-E (rev. 7/2014)
Health Carrier External Review Annual Report Form,
Form 216-F (eff. 7/2011)
Independent Review Organization External Review
Annual Report Form, Form 216-G (eff. 7/2011)
Self-Insured Plan Opt-In to Virginia External
Review Process, Form 216-H (eff. 7/2011)
VA.R. Doc. No. R19-5970; Filed April 23, 2019, 12:15 p.m.