Chapter 216. Rules Governing Internal Appeal and External ReviewRead Chapter
- Part I.Read allGeneral
- Section 10
- Scope and purpose
- Section 20
- Definitions
- Part II.Read allInternal Appeal
- Section 30
- General requirements
- Section 40
- Minimum appeal requirements
- Section 45
- Exhaustion
- Section 50
- Urgent care appeals
- Section 60
- Concurrent review decisions
- Section 65
- Exception request for prescription drugs
- Section 70
- Notification requirements
- Part III.Read allExternal Review
- Section 80
- Incomplete or ineligible determinations
- Section 90
- Expedited external review
- Section 100
- Qualifications for independent review organizations
- Section 110
- External review reporting requirements
- Section 120
- Funding of external review
- Section 130
- Self-insured plans
- FORMS
- FORMS (14VAC5-216)