38.2-322 - Standardized claims forms. - Virginia Statutes

§ 38.2-322. Standardized claims forms.

A. No accident and sickness insurer, health maintenance organization, healthservices plan, or optometric services plan licensed in the Commonwealth shallrefuse to accept, as a standard claims form for physician services or forservices provided by chiropractors, optometrists, opticians, professionalcounselors, psychologists, clinical social workers, podiatrists, physicaltherapists, clinical nurse specialists who render mental health services,audiologists, and speech pathologists, the standardized HCFA-1500 healthinsurance claims form, or its successor as it may be amended from time totime. However, nothing in this section shall prohibit an insurer, healthmaintenance organization, health services plan, or optometric services planfrom accepting any other claims form.

B. No accident and sickness insurer, health maintenance organization, orhealth services plan licensed in the Commonwealth shall refuse to accept as astandard claims form for hospital services the standardized UB-82 claimsform, or its successor as it may be amended from time to time. However,nothing in this section shall prohibit an accident and sickness insurer,health maintenance organization, or health services plan from accepting anyother claims form.

C. No accident and sickness insurer, health maintenance organization, healthservices plan, or dental services plan licensed in the Commonwealth shallrefuse to accept as a standard claims form for dental services thestandardized ADA form prepared by the American Dental Association, or itssuccessor as it may be amended from time to time. However, nothing in thissection shall prohibit an accident and sickness insurer, health maintenanceorganization, health services plan, or dental services plan from acceptingany other claims form.

D. The forms specified in this section may be modified as necessary toaccommodate the transmission and administration of claims by electronic means.

E. After July 1, 1998, no health maintenance organization authorized totransact business in this Commonwealth and no health insurer, health servicesplan or preferred provider organization authorized to offer health benefitsin this Commonwealth that requires the use of the Physicians' CurrentProcedural Terminology (CPT) identifying codes published by the AmericanMedical Association for reporting claims for medical services and procedures,including any standardized form, shall refuse to accept and utilize theseidentifying codes and any appropriate modifiers listed therein when the sameare appropriately used for processing such claims for provider services andprocedures.

(1993, c. 307; 1997, c. 531.)