{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.7.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.7.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.7.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.7.html"}],"law_id":72177,"edition_id":1,"section_id":72177,"structure_id":14765,"section_number":"32.1-137.7","catch_line":"Definitions","history":"1998, cc. 129, 891; 1999, c. 857; 2000, c. 564; 2011, c. 788.","full_text":"As used in this article:\n\t\t“Adverse determination” means a determination by the managed care health insurance plan or its designee utilization review entity that, based upon information provided, a request for a benefit upon application of any utilization review technique does not meet the managed care health insurance plan’s requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit. When the policy, contract, plan, certificate, or evidence of coverage includes coverage for prescription drugs and the health service rendered or proposed to be rendered is a prescription for the alleviation of cancer pain, any adverse determination shall be made within 24 hours of the request for coverage.\n\t\t“Commission” means the Virginia State Corporation Commission.\n\t\t“Covered person” means a subscriber, policyholder, member, enrollee or dependent, as the case may be, under a policy or contract issued or issued for delivery in Virginia by a managed care health insurance plan licensee, insurer, health services plan, or preferred provider organization.\n\t\t“Evidence of coverage” includes any certificate, individual or group agreement or contract, or identification card or related documents issued in conjunction with the certificate, agreement or contract, issued to a subscriber setting out the coverage and other rights to which a covered person is entitled.\n\t\t“Final adverse determination” means an adverse determination involving a covered benefit that has been upheld by a managed care health insurance plan, or its designee utilization review entity, at the completion of the managed care health insurance plan’s internal appeal process.\n\t\t“Medical director” means a physician licensed to practice medicine in the Commonwealth of Virginia who is an employee of a utilization review entity responsible for compliance with the provisions of this article.\n\t\t“Peer of the treating health care provider” means a physician or other health care professional who holds a nonrestricted license in the Commonwealth of Virginia or under a comparable licensing law of a state of the United States and in the same or similar specialty as typically manages the medical condition, procedure or treatment under review.\n\t\t“Physician advisor” means a physician licensed to practice medicine in the Commonwealth of Virginia or under a comparable licensing law of a state of the United States who provides medical advice or information to a private review agent or a utilization review entity in connection with its utilization review activities.\n\t\t“Private review agent” means a person or entity performing utilization reviews, except that the term shall not include the following entities or employees of any such entity so long as they conduct utilization reviews solely for subscribers, policyholders, members or enrollees:\n\n1\n\nA health maintenance organization authorized to transact business in Virginia; or2\n\nA health insurer, hospital service corporation, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth.\n\t\t\t“Treating health care provider” or “provider” means a licensed health care provider who renders or proposes to render health care services to a covered person.\n\t\t\t“Utilization review” means a system for reviewing the necessity, appropriateness and efficiency of hospital, medical or other health care services rendered or proposed to be rendered to a patient or group of patients for the purpose of determining whether such services should be covered or provided by an insurer, health services plan, managed care health insurance plan licensee, or other entity or person. For purposes of this article, “utilization review” shall include, but not be limited to, preadmission, concurrent and retrospective medical necessity determination, and review related to the appropriateness of the site at which services were or are to be delivered. “Utilization review” shall not include (i) any review of issues concerning insurance contract coverage or contractual restrictions on facilities to be used for the provision of services, (ii) any review of patient information by an employee of or consultant to any licensed hospital for patients of such hospital, or (iii) any determination by an insurer as to the reasonableness and necessity of services for the treatment and care of an injury suffered by an insured for which reimbursement is claimed under a contract of insurance covering any classes of insurance defined in §§ 38.2-117, 38.2-118, 38.2-119, 38.2-124, 38.2-125, 38.2-126, 38.2-130, 38.2-131, 38.2-132, and 38.2-134.\n\t\t\t“Utilization review entity” or “entity” means a person or entity performing utilization review.\n\t\t\t“Utilization review plan” or “plan” means a written procedure for performing review.","order_by":null,"text":{"0":{"id":260011,"text":"As used in this article:\n\t\t“Adverse determination” means a determination by the managed care health insurance plan or its designee utilization review entity that, based upon information provided, a request for a benefit upon application of any utilization review technique does not meet the managed care health insurance plan’s requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit. When the policy, contract, plan, certificate, or evidence of coverage includes coverage for prescription drugs and the health service rendered or proposed to be rendered is a prescription for the alleviation of cancer pain, any adverse determination shall be made within 24 hours of the request for coverage.\n\t\t“Commission” means the Virginia State Corporation Commission.\n\t\t“Covered person” means a subscriber, policyholder, member, enrollee or dependent, as the case may be, under a policy or contract issued or issued for delivery in Virginia by a managed care health insurance plan licensee, insurer, health services plan, or preferred provider organization.\n\t\t“Evidence of coverage” includes any certificate, individual or group agreement or contract, or identification card or related documents issued in conjunction with the certificate, agreement or contract, issued to a subscriber setting out the coverage and other rights to which a covered person is entitled.\n\t\t“Final adverse determination” means an adverse determination involving a covered benefit that has been upheld by a managed care health insurance plan, or its designee utilization review entity, at the completion of the managed care health insurance plan’s internal appeal process.\n\t\t“Medical director” means a physician licensed to practice medicine in the Commonwealth of Virginia who is an employee of a utilization review entity responsible for compliance with the provisions of this article.\n\t\t“Peer of the treating health care provider” means a physician or other health care professional who holds a nonrestricted license in the Commonwealth of Virginia or under a comparable licensing law of a state of the United States and in the same or similar specialty as typically manages the medical condition, procedure or treatment under review.\n\t\t“Physician advisor” means a physician licensed to practice medicine in the Commonwealth of Virginia or under a comparable licensing law of a state of the United States who provides medical advice or information to a private review agent or a utilization review entity in connection with its utilization review activities.\n\t\t“Private review agent” means a person or entity performing utilization reviews, except that the term shall not include the following entities or employees of any such entity so long as they conduct utilization reviews solely for subscribers, policyholders, members or enrollees:","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1,"next_prefix":"1"},"1":{"id":260012,"text":"A health maintenance organization authorized to transact business in Virginia; or","type":"section","prefixes":["1"],"prefix":"1","entire_prefix":"1","prefix_anchor":"1","level":1,"prior_prefix":"","next_prefix":"2"},"2":{"id":260013,"text":"A health insurer, hospital service corporation, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth.\n\t\t\t“Treating health care provider” or “provider” means a licensed health care provider who renders or proposes to render health care services to a covered person.\n\t\t\t“Utilization review” means a system for reviewing the necessity, appropriateness and efficiency of hospital, medical or other health care services rendered or proposed to be rendered to a patient or group of patients for the purpose of determining whether such services should be covered or provided by an insurer, health services plan, managed care health insurance plan licensee, or other entity or person. For purposes of this article, “utilization review” shall include, but not be limited to, preadmission, concurrent and retrospective medical necessity determination, and review related to the appropriateness of the site at which services were or are to be delivered. “Utilization review” shall not include (i) any review of issues concerning insurance contract coverage or contractual restrictions on facilities to be used for the provision of services, (ii) any review of patient information by an employee of or consultant to any licensed hospital for patients of such hospital, or (iii) any determination by an insurer as to the reasonableness and necessity of services for the treatment and care of an injury suffered by an insured for which reimbursement is claimed under a contract of insurance covering any classes of insurance defined in §§ 38.2-117, 38.2-118, 38.2-119, 38.2-124, 38.2-125, 38.2-126, 38.2-130, 38.2-131, 38.2-132, and 38.2-134.\n\t\t\t“Utilization review entity” or “entity” means a person or entity performing utilization review.\n\t\t\t“Utilization review plan” or “plan” means a written procedure for performing review.","type":"section","prefixes":["2"],"prefix":"2","entire_prefix":"2","prefix_anchor":"2","level":1,"prior_prefix":"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.7\/","history_text":"

This law was first created in 1998. The record of its establishment is cataloged in chapters 129<\/a> and 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 3 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, chapter 857<\/a>; in 2000, chapter 564<\/a>; in 2011, chapter 788<\/a>.<\/p>","references":[{"id":68317,"section_number":"2.2-2818","catch_line":"Health and related insurance for state employees","order_by":null,"url":"\/2.2-2818\/"},{"id":58079,"section_number":"38.2-3407.10","catch_line":"Health care provider panels","order_by":null,"url":"\/38.2-3407.10\/"},{"id":62548,"section_number":"38.2-4509","catch_line":"Application of certain laws","order_by":null,"url":"\/38.2-4509\/"},{"id":75528,"section_number":"38.2-5904","catch_line":"Office of the Managed Care Ombudsman established; responsibilities","order_by":null,"url":"\/38.2-5904\/"}],"refers_to":[{"id":83683,"section_number":"38.2-117","catch_line":"Personal injury liability","order_by":null,"url":"\/38.2-117\/"},{"id":58741,"section_number":"38.2-118","catch_line":"Property damage liability","order_by":null,"url":"\/38.2-118\/"},{"id":80898,"section_number":"38.2-119","catch_line":"Workers' compensation and employers' liability","order_by":null,"url":"\/38.2-119\/"},{"id":66976,"section_number":"38.2-124","catch_line":"Motor vehicle","order_by":null,"url":"\/38.2-124\/"},{"id":66153,"section_number":"38.2-125","catch_line":"Aircraft","order_by":null,"url":"\/38.2-125\/"},{"id":63990,"section_number":"38.2-126","catch_line":"Marine","order_by":null,"url":"\/38.2-126\/"},{"id":75005,"section_number":"38.2-130","catch_line":"Homeowners insurance","order_by":null,"url":"\/38.2-130\/"},{"id":79979,"section_number":"38.2-131","catch_line":"Farmowners insurance","order_by":null,"url":"\/38.2-131\/"},{"id":60601,"section_number":"38.2-132","catch_line":"Commercial multi-peril insurance","order_by":null,"url":"\/38.2-132\/"},{"id":74943,"section_number":"38.2-134","catch_line":"Definitions to include other insurance of same general kind","order_by":null,"url":"\/38.2-134\/"}],"permalink":{"id":203155,"object_type":"law","relational_id":72177,"identifier":"32.1-137.7","token":"32.1\/5\/1.2\/32.1-137.7","url":"\/32.1-137.7\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.7\/","token":"32.1\/5\/1.2\/32.1-137.7","dublin_core":{"Title":"Definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.7","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

As used in this article:\n\t\t“Adverse determination” means a determination by the managed care health insurance plan<\/span> or its designee utilization review entity<\/span> that, based upon information provided, a request for a benefit upon application of any utilization review technique does not meet the managed care health insurance plan<\/span>’s requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit. When the policy, contract<\/span>, plan<\/span>, certificate, or evidence of coverage<\/span> includes coverage for prescription drugs and the health service rendered or proposed to be rendered is a prescription for the alleviation of cancer pain, any adverse determination shall be made within 24 hours of the request for coverage.\n\t\t“Commission<\/span>” means the Virginia State Corporation Commission<\/span>.\n\t\t“Covered person<\/span>” means a subscriber, policyholder, member, enrollee or dependent, as the case may be, under a policy or contract<\/span> issued or issued for delivery in Virginia by a managed care health insurance plan<\/span> licensee, insurer, health services plan<\/span>, or preferred provider organization.\n\t\t“Evidence of coverage<\/span>” includes any certificate, individual or group agreement or contract<\/span>, or identification card or related documents issued in conjunction with the certificate, agreement or contract<\/span>, issued to a subscriber setting out the coverage and other rights to which a covered person<\/span> is entitled.\n\t\t“Final adverse determination<\/span>” means an adverse determination involving a covered benefit that has been upheld by a managed care health insurance plan<\/span>, or its designee utilization review entity<\/span>, at the completion of the managed care health insurance plan<\/span>’s internal appeal<\/span> process.\n\t\t“Medical director<\/span>” means a physician licensed to practice medicine in the Commonwealth of Virginia who is an employee of a utilization review entity<\/span> responsible for compliance with the provisions of this article.\n\t\t“Peer of the treating health care provider<\/span><\/span>” means a physician or other health care professional who holds a nonrestricted license in the Commonwealth of Virginia or under a comparable licensing law<\/span> of a state of the United States and in the same or similar specialty as typically manages the medical condition, procedure or treatment under review.\n\t\t“Physician advisor<\/span>” means a physician licensed to practice medicine in the Commonwealth of Virginia or under a comparable licensing law<\/span> of a state of the United States who provides medical advice or information to a private review agent<\/span> or a utilization review entity<\/span> in connection with its utilization review activities.\n\t\t“Private review agent<\/span>” means a person or entity performing utilization reviews<\/span>, except that the term shall not include the following entities or employees of any such entity so long as they conduct utilization reviews<\/span> solely for subscribers, policyholders, members or enrollees:<\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> A health maintenance organization authorized to transact business in Virginia; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> A health insurer, hospital service corporation, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth.\n\t\t\t“Treating health care provider<\/span>” or “provider” means a licensed health care provider who renders or proposes to render health care services to a covered person<\/span>.\n\t\t\t“Utilization review” means a system for reviewing the necessity, appropriateness and efficiency of hospital, medical or other health care services rendered or proposed to be rendered to a patient or group of patients for the purpose of determining whether such services should be covered or provided by an insurer, health services plan, managed care health insurance plan licensee, or other entity or person. For purposes of this article, “utilization review” shall include, but not be limited to, preadmission, concurrent and retrospective medical necessity determination, and review related to the appropriateness of the site at which services were or are to be delivered. “Utilization review” shall not include (i) any review of issues<\/span> concerning insurance contract<\/span> coverage or contractual restrictions on facilities to be used for the provision of services, (ii) any review of patient information by an employee of or consultant to any licensed hospital for patients of such hospital, or (iii) any determination by an insurer as to the reasonableness and necessity of services for the treatment and care of an injury suffered by an insured for which reimbursement is claimed under a contract<\/span> of insurance covering any classes of insurance defined in §§ 38.2-117<\/a>, 38.2-118<\/a>, 38.2-119<\/a>, 38.2-124<\/a>, 38.2-125<\/a>, 38.2-126<\/a>, 38.2-130<\/a>, 38.2-131<\/a>, 38.2-132<\/a>, and 38.2-134<\/a>.\n\t\t\t“Utilization review entity<\/span>” or “entity” means a person or entity performing utilization review.\n\t\t\t“Utilization review plan<\/span>” or “plan” means a written procedure for performing review. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEFINITIONS (\u00a7 32.1-137.7)\n\nAs used in this article:\n\t\t“Adverse determination” means a determination by the managed care\nhealth insurance plan or its designee utilization review entity that, based upon\ninformation provided, a request for a benefit upon application of any\nutilization review technique does not meet the managed care health insurance\nplan’s requirements for medical necessity, appropriateness, health care\nsetting, level of care, or effectiveness or is determined to be experimental or\ninvestigational and the requested benefit is therefore denied, reduced, or\nterminated or payment is not provided or made, in whole or in part, for the\nbenefit. When the policy, contract, plan, certificate, or evidence of coverage\nincludes coverage for prescription drugs and the health service rendered or\nproposed to be rendered is a prescription for the alleviation of cancer pain,\nany adverse determination shall be made within 24 hours of the request for\ncoverage.\n\t\t“Commission” means the Virginia State Corporation Commission.\n\t\t“Covered person” means a subscriber, policyholder, member,\nenrollee or dependent, as the case may be, under a policy or contract issued or\nissued for delivery in Virginia by a managed care health insurance plan\nlicensee, insurer, health services plan, or preferred provider organization.\n\t\t“Evidence of coverage” includes any certificate, individual or\ngroup agreement or contract, or identification card or related documents issued\nin conjunction with the certificate, agreement or contract, issued to a\nsubscriber setting out the coverage and other rights to which a covered person\nis entitled.\n\t\t“Final adverse determination” means an adverse determination\ninvolving a covered benefit that has been upheld by a managed care health\ninsurance plan, or its designee utilization review entity, at the completion of\nthe managed care health insurance plan’s internal appeal process.\n\t\t“Medical director” means a physician licensed to practice medicine\nin the Commonwealth of Virginia who is an employee of a utilization review\nentity responsible for compliance with the provisions of this article.\n\t\t“Peer of the treating health care provider” means a physician or\nother health care professional who holds a nonrestricted license in the\nCommonwealth of Virginia or under a comparable licensing law of a state of the\nUnited States and in the same or similar specialty as typically manages the\nmedical condition, procedure or treatment under review.\n\t\t“Physician advisor” means a physician licensed to practice\nmedicine in the Commonwealth of Virginia or under a comparable licensing law of\na state of the United States who provides medical advice or information to a\nprivate review agent or a utilization review entity in connection with its\nutilization review activities.\n\t\t“Private review agent” means a person or entity performing\nutilization reviews, except that the term shall not include the following\nentities or employees of any such entity so long as they conduct utilization\nreviews solely for subscribers, policyholders, members or enrollees:\n\n1. A health maintenance organization authorized to transact business in\nVirginia; or\n\n2. A health insurer, hospital service corporation, health services plan or\npreferred provider organization authorized to offer health benefits in this\nCommonwealth.\n\t\t\t“Treating health care provider” or “provider” means a\nlicensed health care provider who renders or proposes to render health care\nservices to a covered person.\n\t\t\t“Utilization review” means a system for reviewing the necessity,\nappropriateness and efficiency of hospital, medical or other health care\nservices rendered or proposed to be rendered to a patient or group of patients\nfor the purpose of determining whether such services should be covered or\nprovided by an insurer, health services plan, managed care health insurance plan\nlicensee, or other entity or person. For purposes of this article,\n“utilization review” shall include, but not be limited to,\npreadmission, concurrent and retrospective medical necessity determination, and\nreview related to the appropriateness of the site at which services were or are\nto be delivered. “Utilization review” shall not include (i) any\nreview of issues concerning insurance contract coverage or contractual\nrestrictions on facilities to be used for the provision of services, (ii) any\nreview of patient information by an employee of or consultant to any licensed\nhospital for patients of such hospital, or (iii) any determination by an insurer\nas to the reasonableness and necessity of services for the treatment and care of\nan injury suffered by an insured for which reimbursement is claimed under a\ncontract of insurance covering any classes of insurance defined in §§\n38.2-117, 38.2-118, 38.2-119, 38.2-124, 38.2-125, 38.2-126, 38.2-130, 38.2-131,\n38.2-132, and 38.2-134.\n\t\t\t“Utilization review entity” or “entity” means a\nperson or entity performing utilization review.\n\t\t\t“Utilization review plan” or “plan” means a written\nprocedure for performing review.\n\nHISTORY: 1998, cc. 129, 891; 1999, c. 857; 2000, c. 564; 2011, 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}}