Administrative Code

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Virginia Administrative Code
Title 16. Labor And Employment
Agency 30. Virginia Workers' Compensation Commission
Chapter 60. Procedural Regulations Governing the Administration of Medical Costs Peer Review by the Regional Peer Review Committees under the Virginia Workers' Compensation Act

16VAC30-60-80. Requests for peer review.

A. Requests for peer review shall be made on a form prescribed by the Statewide Coordinating Committee and shall set forth or be accompanied by the following:

1. The name and address of the party requesting review;

2. The names of any physicians or clinics involved;

3. The name of the patient;

4. A description of the injury;

5. A description of the medical treatment, services, or costs complained of;

6. A description of where and when the treatment or services took place; and

7. A copy of any other relevant information forming the basis of the request for review, including any evidence indicating that the fees charged are different from those that prevail in the same community for similar treatment when the treatment is paid for by the injured person.

B. Requests for peer review shall be made to the Secretary of the Statewide Coordinating Committee. Requests may be submitted by the commission, a treating physician, any insurance company providing coverage for the cost of services paid for in whole or in part pursuant to the Workers' Compensation Act, or any employer.

C. The Secretary of the Statewide Coordinating Committee shall refer each completed request for review to the chairman of the appropriate regional peer review committee or to a member designated by the chairman.

Statutory Authority

§ 65.2-1305 of the Code of Virginia.

Historical Notes

Derived from VR405-02-01 § 2.1, eff. Jan. 9, 1981; July 16, 1993.

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