Administrative Code

Virginia Administrative Code
11/28/2021

Part I. General Procedural Requirements

14VAC10-10-10. Payer of last resort.

The Virginia Birth-Related Neurological Injury Compensation Program (Program) is a payer of last resort. Each admitted claimant's primary insurance and other sources of coverage should be billed for covered services before the Program is asked to pay for a service. An admitted claimant may not receive reimbursement or compensation from the Program for expenses for items or services, or for reimbursements, that he has received or is entitled to receive by contract, state law, or federal law, or from another source, except to the extent that it is prohibited by federal law.

Statutory Authority

§ 38.2-5002.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 33, Issue 23, eff. July 10, 2017.

14VAC10-10-20. Primary insurance.

A. Medical services that are required to be precertified, preauthorized, or authorized by the admitted claimant's primary insurance provider may not be payable by the Virginia Birth-Related Neurological Injury Compensation Program (Program) if the primary insurance carrier's certification or authorization process has not been satisfied.

B. Admitted claimants must utilize the primary insurer's in-network providers and facilities unless otherwise authorized by the Program. Utilizing non-network or nonparticipating providers or facilities may result in reduced payment or nonpayment of incurred expenses.

Statutory Authority

§ 38.2-5002.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 33, Issue 23, eff. July 10, 2017.

14VAC10-10-30. Medical review.

The Virginia Birth-Related Neurological Injury Compensation Program reserves the right to submit requests for services or equipment for independent medical review to determine medical necessity or appropriateness of care prior to authorizing payment.

Statutory Authority

§ 38.2-5002.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 33, Issue 23, eff. July 10, 2017.

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