{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.15.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.15.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.15.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.15.html"}],"law_id":57196,"edition_id":1,"section_id":57196,"structure_id":14765,"section_number":"32.1-137.15","catch_line":"Adverse determination; appeal","history":"1998, c. 891; 1999, cc. 643, 649, 857; 2000, c. 922; 2010, c. 395; 2011, c. 788.","full_text":"Each entity shall establish an internal appeals process, including a process for urgent care appeals, to consider any adverse determination that is appealed by a covered person, his representative, or his provider in accordance with the provisions of \u00a7 38.2-3558.","order_by":null,"text":{"0":{"id":209510,"text":"Each entity shall establish an internal appeals process, including a process for urgent care appeals, to consider any adverse determination that is appealed by a covered person, his representative, or his provider in accordance with the provisions of \u00a7 38.2-3558.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1}},"ancestry":[{"id":14765,"edition_id":1,"name":"Utilization Review Standards and Appeals","identifier":"1.2","label":"article","depth":3,"order_by":1,"parent_id":12728,"metadata":{},"date_created":"2026-06-26 03:49:48","date_modified":"2026-06-26 03:49:48","permalink":{"id":203121,"object_type":"structure","relational_id":14765,"identifier":"1.2","token":"32.1\/5\/1.2","url":"\/32.1\/5\/1.2\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12728,"edition_id":1,"name":"Regulation of Medical Care Facilities and Services","identifier":"5","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":202855,"object_type":"structure","relational_id":12728,"identifier":"5","token":"32.1\/5","url":"\/32.1\/5\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":56529,"structure_id":14765,"section_number":"32.1-137.10","catch_line":"Utilization review plan required","url":"\/32.1-137.10\/","token":"32.1\/5\/1.2\/32.1-137.10","metadata":false},{"id":83750,"structure_id":14765,"section_number":"32.1-137.11","catch_line":"Accessibility of utilization review entity","url":"\/32.1-137.11\/","token":"32.1\/5\/1.2\/32.1-137.11","metadata":false},{"id":86108,"structure_id":14765,"section_number":"32.1-137.12","catch_line":"Emergencies; extensions; access to and confidentiality of patient-specific medical records and information","url":"\/32.1-137.12\/","token":"32.1\/5\/1.2\/32.1-137.12","metadata":false},{"id":64658,"structure_id":14765,"section_number":"32.1-137.13","catch_line":"Adverse determination","url":"\/32.1-137.13\/","token":"32.1\/5\/1.2\/32.1-137.13","metadata":false},{"id":68683,"structure_id":14765,"section_number":"32.1-137.14","catch_line":"Reconsideration of adverse determination","url":"\/32.1-137.14\/","token":"32.1\/5\/1.2\/32.1-137.14","metadata":false},{"id":57196,"structure_id":14765,"section_number":"32.1-137.15","catch_line":"Adverse determination; appeal","url":"\/32.1-137.15\/","token":"32.1\/5\/1.2\/32.1-137.15","metadata":false},{"id":74476,"structure_id":14765,"section_number":"32.1-137.16","catch_line":"Records","url":"\/32.1-137.16\/","token":"32.1\/5\/1.2\/32.1-137.16","metadata":false},{"id":57237,"structure_id":14765,"section_number":"32.1-137.17","catch_line":"Limitation on Commissioner's jurisdiction","url":"\/32.1-137.17\/","token":"32.1\/5\/1.2\/32.1-137.17","metadata":false},{"id":72177,"structure_id":14765,"section_number":"32.1-137.7","catch_line":"Definitions","url":"\/32.1-137.7\/","token":"32.1\/5\/1.2\/32.1-137.7","metadata":false},{"id":78307,"structure_id":14765,"section_number":"32.1-137.8","catch_line":"Application to and compliance by utilization review entities","url":"\/32.1-137.8\/","token":"32.1\/5\/1.2\/32.1-137.8","metadata":false},{"id":59792,"structure_id":14765,"section_number":"32.1-137.9","catch_line":"Requirements and standards for utilization review entities","url":"\/32.1-137.9\/","token":"32.1\/5\/1.2\/32.1-137.9","metadata":false}],"previous_section":{"id":68683,"structure_id":14765,"section_number":"32.1-137.14","catch_line":"Reconsideration of adverse determination","url":"\/32.1-137.14\/","token":"32.1\/5\/1.2\/32.1-137.14","metadata":false},"next_section":{"id":74476,"structure_id":14765,"section_number":"32.1-137.16","catch_line":"Records","url":"\/32.1-137.16\/","token":"32.1\/5\/1.2\/32.1-137.16","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.15\/","history_text":"<p>This law was first created in 1998. The record of its establishment is cataloged in chapter <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?981+ful+CHAP0891\">891<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 4 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1999, chapters <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?991+ful+CHAP0643\">643<\/a>, <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?991+ful+CHAP0649\">649<\/a>, and <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?991+ful+CHAP0857\">857<\/a>; in 2000, chapter <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?001+ful+CHAP0922\">922<\/a>; in 2010, chapter <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?101+ful+CHAP0395\">395<\/a>; in 2011, chapter <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?111+ful+CHAP0788\">788<\/a>.<\/p>","references":[{"id":56529,"section_number":"32.1-137.10","catch_line":"Utilization review plan required","order_by":null,"url":"\/32.1-137.10\/"},{"id":64658,"section_number":"32.1-137.13","catch_line":"Adverse determination","order_by":null,"url":"\/32.1-137.13\/"},{"id":68683,"section_number":"32.1-137.14","catch_line":"Reconsideration of adverse determination","order_by":null,"url":"\/32.1-137.14\/"}],"refers_to":[{"id":56843,"section_number":"38.2-3558","catch_line":"Health carrier's internal appeal process","order_by":null,"url":"\/38.2-3558\/"}],"permalink":{"id":203143,"object_type":"law","relational_id":57196,"identifier":"32.1-137.15","token":"32.1\/5\/1.2\/32.1-137.15","url":"\/32.1-137.15\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.15\/","token":"32.1\/5\/1.2\/32.1-137.15","dublin_core":{"Title":"Adverse determination; appeal","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.15","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t<section><p>Each <span class=\"dictionary\">entity<\/span> shall establish an internal <span class=\"dictionary\">appeals<\/span> process, including a process for urgent care <span class=\"dictionary\">appeals<\/span>, to consider any <span class=\"dictionary\">adverse determination<\/span> that is appealed by a <span class=\"dictionary\">covered person<\/span>, his representative, or his <span class=\"dictionary\">provider<\/span> in accordance with the provisions of \u00a7&nbsp;<a class=\"law\" title=\"Health carrier&#039;s internal appeal process\" href=\"\/38.2-3558\/\">38.2-3558<\/a>.<\/p><\/section>","plain_text":"                                 CODE OF VIRGINIA\n\nADVERSE DETERMINATION; APPEAL (\u00a7 32.1-137.15)\n\nEach entity shall establish an internal appeals process, including a process for\nurgent care appeals, to consider any adverse determination that is appealed by a\ncovered person, his representative, or his provider in accordance with the\nprovisions of \u00a7 38.2-3558.\n\nHISTORY: 1998, c. 891; 1999, cc. 643, 649, 857; 2000, c. 922; 2010, c. 395;\n2011, c. 788.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}