32.1-138.9 - Standards for approval. - Virginia Statutes

§ 32.1-138.9. Standards for approval.

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

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

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

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

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

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

(1990, c. 826, § 38.2-5302; 1998, c. 129.)