{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-322.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-322.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-322.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-322.html"}],"law_id":65634,"edition_id":1,"section_id":65634,"structure_id":13680,"section_number":"38.2-322","catch_line":"Standardized claims forms","history":"1993, c. 307; 1997, c. 531.","full_text":"A\n\nNo accident and sickness insurer, health maintenance organization, health services plan, or optometric services plan licensed in the Commonwealth shall refuse to accept, as a standard claims form for physician services or for services provided by chiropractors, optometrists, opticians, professional counselors, psychologists, clinical social workers, podiatrists, physical therapists, clinical nurse specialists who render mental health services, audiologists, and speech pathologists, the standardized HCFA-1500 health insurance claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an insurer, health maintenance organization, health services plan, or optometric services plan from accepting any other claims form.B\n\nNo accident and sickness insurer, health maintenance organization, or health services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for hospital services the standardized UB-82 claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, or health services plan from accepting any other claims form.C\n\nNo accident and sickness insurer, health maintenance organization, health services plan, or dental services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for dental services the standardized ADA form prepared by the American Dental Association, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, health services plan, or dental services plan from accepting any other claims form.D\n\nThe forms specified in this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means.E\n\nAfter July 1, 1998, no health maintenance organization authorized to transact business in this Commonwealth and no health insurer, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth that requires the use of the Physicians’ Current Procedural Terminology (CPT) identifying codes published by the American Medical Association for reporting claims for medical services and procedures, including any standardized form, shall refuse to accept and utilize these identifying codes and any appropriate modifiers listed therein when the same are appropriately used for processing such claims for provider services and procedures.","order_by":null,"text":{"0":{"id":238551,"text":"No accident and sickness insurer, health maintenance organization, health services plan, or optometric services plan licensed in the Commonwealth shall refuse to accept, as a standard claims form for physician services or for services provided by chiropractors, optometrists, opticians, professional counselors, psychologists, clinical social workers, podiatrists, physical therapists, clinical nurse specialists who render mental health services, audiologists, and speech pathologists, the standardized HCFA-1500 health insurance claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an insurer, health maintenance organization, health services plan, or optometric services plan from accepting any other claims form.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":238552,"text":"No accident and sickness insurer, health maintenance organization, or health services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for hospital services the standardized UB-82 claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, or health services plan from accepting any other claims form.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":238553,"text":"No accident and sickness insurer, health maintenance organization, health services plan, or dental services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for dental services the standardized ADA form prepared by the American Dental Association, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, health services plan, or dental services plan from accepting any other claims form.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":238554,"text":"The forms specified in this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":238555,"text":"After July 1, 1998, no health maintenance organization authorized to transact business in this Commonwealth and no health insurer, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth that requires the use of the Physicians’ Current Procedural Terminology (CPT) identifying codes published by the American Medical Association for reporting claims for medical services and procedures, including any standardized form, shall refuse to accept and utilize these identifying codes and any appropriate modifiers listed therein when the same are appropriately used for processing such claims for provider services and procedures.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":13680,"edition_id":1,"name":"Provisions Relating to Insurance Policies and Contracts","identifier":"3","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:45:32","date_modified":"2026-06-26 03:45:32","permalink":{"id":214203,"object_type":"structure","relational_id":13680,"identifier":"3","token":"38.2\/3","url":"\/38.2\/3\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":67920,"structure_id":13680,"section_number":"38.2-300","catch_line":"Scope of chapter","url":"\/38.2-300\/","token":"38.2\/3\/38.2-300","metadata":false},{"id":66037,"structure_id":13680,"section_number":"38.2-301","catch_line":"Insurable interest required; life, accident and sickness insurance","url":"\/38.2-301\/","token":"38.2\/3\/38.2-301","metadata":false},{"id":76812,"structure_id":13680,"section_number":"38.2-302","catch_line":"Life, accident, and sickness insurance; application required","url":"\/38.2-302\/","token":"38.2\/3\/38.2-302","metadata":false},{"id":58792,"structure_id":13680,"section_number":"38.2-303","catch_line":"Insurable interest required; property insurance","url":"\/38.2-303\/","token":"38.2\/3\/38.2-303","metadata":false},{"id":79372,"structure_id":13680,"section_number":"38.2-304","catch_line":"Contracts of temporary insurance; duration; what deemed to include","url":"\/38.2-304\/","token":"38.2\/3\/38.2-304","metadata":false},{"id":68773,"structure_id":13680,"section_number":"38.2-305","catch_line":"Contents of policies","url":"\/38.2-305\/","token":"38.2\/3\/38.2-305","metadata":false},{"id":76860,"structure_id":13680,"section_number":"38.2-306","catch_line":"Additional contents","url":"\/38.2-306\/","token":"38.2\/3\/38.2-306","metadata":false},{"id":84098,"structure_id":13680,"section_number":"38.2-307","catch_line":"Charter and bylaw provisions in policies","url":"\/38.2-307\/","token":"38.2\/3\/38.2-307","metadata":false},{"id":69279,"structure_id":13680,"section_number":"38.2-308","catch_line":"Contingent liability provisions in policies issued by certain mutual insurers","url":"\/38.2-308\/","token":"38.2\/3\/38.2-308","metadata":false},{"id":65281,"structure_id":13680,"section_number":"38.2-309","catch_line":"When answers or statements of applicant do not bar recovery on policy","url":"\/38.2-309\/","token":"38.2\/3\/38.2-309","metadata":false},{"id":67536,"structure_id":13680,"section_number":"38.2-310","catch_line":"All fees, charges, etc., to be stated in policy","url":"\/38.2-310\/","token":"38.2\/3\/38.2-310","metadata":false},{"id":72176,"structure_id":13680,"section_number":"38.2-311","catch_line":"Type size in which conditions and restrictions to be printed","url":"\/38.2-311\/","token":"38.2\/3\/38.2-311","metadata":false},{"id":75172,"structure_id":13680,"section_number":"38.2-312","catch_line":"Provisions limiting jurisdiction, or requiring construction of contracts by law of other states, prohibited","url":"\/38.2-312\/","token":"38.2\/3\/38.2-312","metadata":false},{"id":74805,"structure_id":13680,"section_number":"38.2-313","catch_line":"Where certain contracts deemed made","url":"\/38.2-313\/","token":"38.2\/3\/38.2-313","metadata":false},{"id":56872,"structure_id":13680,"section_number":"38.2-314","catch_line":"Limitation of action and proof of loss","url":"\/38.2-314\/","token":"38.2\/3\/38.2-314","metadata":false},{"id":69924,"structure_id":13680,"section_number":"38.2-315","catch_line":"Intervening breach","url":"\/38.2-315\/","token":"38.2\/3\/38.2-315","metadata":false},{"id":60466,"structure_id":13680,"section_number":"38.2-316","catch_line":"Policy forms to be filed with Commission; notice of approval or disapproval; exceptions","url":"\/38.2-316\/","token":"38.2\/3\/38.2-316","metadata":false},{"id":85582,"structure_id":13680,"section_number":"38.2-316.1","catch_line":"Premium rates","url":"\/38.2-316.1\/","token":"38.2\/3\/38.2-316.1","metadata":false},{"id":71148,"structure_id":13680,"section_number":"38.2-316.2","catch_line":"Dental carriers; annual actual loss ratio report","url":"\/38.2-316.2\/","token":"38.2\/3\/38.2-316.2","metadata":false},{"id":77188,"structure_id":13680,"section_number":"38.2-317","catch_line":"Delivery and use of certain policies and endorsements","url":"\/38.2-317\/","token":"38.2\/3\/38.2-317","metadata":false},{"id":64949,"structure_id":13680,"section_number":"38.2-318","catch_line":"Validity of noncomplying forms","url":"\/38.2-318\/","token":"38.2\/3\/38.2-318","metadata":false},{"id":67693,"structure_id":13680,"section_number":"38.2-319","catch_line":"Validity of contracts in violation of law","url":"\/38.2-319\/","token":"38.2\/3\/38.2-319","metadata":false},{"id":71052,"structure_id":13680,"section_number":"38.2-320","catch_line":"Insurer to furnish forms for proof of loss","url":"\/38.2-320\/","token":"38.2\/3\/38.2-320","metadata":false},{"id":60210,"structure_id":13680,"section_number":"38.2-321","catch_line":"Payment discharges insurer","url":"\/38.2-321\/","token":"38.2\/3\/38.2-321","metadata":false},{"id":65634,"structure_id":13680,"section_number":"38.2-322","catch_line":"Standardized claims forms","url":"\/38.2-322\/","token":"38.2\/3\/38.2-322","metadata":false},{"id":54659,"structure_id":13680,"section_number":"38.2-323","catch_line":"Repealed","url":"\/38.2-323\/","token":"38.2\/3\/38.2-323","metadata":false},{"id":87300,"structure_id":13680,"section_number":"38.2-324","catch_line":"Disclosure of property damage information","url":"\/38.2-324\/","token":"38.2\/3\/38.2-324","metadata":false},{"id":72048,"structure_id":13680,"section_number":"38.2-325","catch_line":"Electronic delivery","url":"\/38.2-325\/","token":"38.2\/3\/38.2-325","metadata":false},{"id":55944,"structure_id":13680,"section_number":"38.2-326","catch_line":"Plan management functions","url":"\/38.2-326\/","token":"38.2\/3\/38.2-326","metadata":false}],"previous_section":{"id":60210,"structure_id":13680,"section_number":"38.2-321","catch_line":"Payment discharges insurer","url":"\/38.2-321\/","token":"38.2\/3\/38.2-321","metadata":false},"next_section":{"id":54659,"structure_id":13680,"section_number":"38.2-323","catch_line":"Repealed","url":"\/38.2-323\/","token":"38.2\/3\/38.2-323","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-322\/","history_text":"

This law was first created in 1993. The record of its establishment is cataloged in chapter 307 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. Unfortunately, the 1993 \u201cActs\u201d aren\u2019t available online. It has been modified 1 time. 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. That modification is as follows: in 1997, chapter 531<\/a>.<\/p>","references":[{"id":55347,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","order_by":null,"url":"\/38.2-4214\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"},{"id":62548,"section_number":"38.2-4509","catch_line":"Application of certain laws","order_by":null,"url":"\/38.2-4509\/"}],"refers_to":false,"permalink":{"id":214301,"object_type":"law","relational_id":65634,"identifier":"38.2-322","token":"38.2\/3\/38.2-322","url":"\/38.2-322\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-322\/","token":"38.2\/3\/38.2-322","dublin_core":{"Title":"Standardized claims forms","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-322","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No accident and sickness insurer<\/span>, health maintenance organization, health services plan<\/span>, or optometric services plan licensed in the Commonwealth shall refuse to accept, as a standard claims form for physician services or for services provided by chiropractors, optometrists, opticians, professional counselors, psychologists, clinical social workers, podiatrists, physical therapists, clinical nurse specialists who render mental health services, audiologists, and speech pathologists, the standardized HCFA-1500 health insurance<\/span> claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an insurer<\/span>, health maintenance organization, health services plan<\/span>, or optometric services plan from accepting any other claims form. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No accident and sickness insurer<\/span>, health maintenance organization, or health services plan<\/span> licensed in the Commonwealth shall refuse to accept as a standard claims form for hospital services the standardized UB-82 claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer<\/span>, health maintenance organization, or health services plan<\/span> from accepting any other claims form. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> No accident and sickness insurer<\/span>, health maintenance organization, health services plan<\/span>, or dental services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for dental services the standardized ADA form prepared by the American Dental Association, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer<\/span>, health maintenance organization, health services plan<\/span>, or dental services plan from accepting any other claims form. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The forms specified in this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> After July 1, 1998, no health maintenance organization authorized to transact business in this Commonwealth and no health insurer<\/span>, health services plan<\/span> or preferred provider organization authorized to offer health benefits in this Commonwealth that requires the use of the Physicians’ Current Procedural Terminology (CPT) identifying codes published by the American Medical Association for reporting claims for medical services and procedures, including any standardized form, shall refuse to accept and utilize these identifying codes and any appropriate modifiers listed therein when the same are appropriately used for processing such claims for provider services and procedures. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nSTANDARDIZED CLAIMS FORMS (\u00a7 38.2-322)\n\nA. No accident and sickness insurer, health maintenance organization, health\nservices plan, or optometric services plan licensed in the Commonwealth shall\nrefuse to accept, as a standard claims form for physician services or for\nservices provided by chiropractors, optometrists, opticians, professional\ncounselors, psychologists, clinical social workers, podiatrists, physical\ntherapists, clinical nurse specialists who render mental health services,\naudiologists, and speech pathologists, the standardized HCFA-1500 health\ninsurance claims form, or its successor as it may be amended from time to time.\nHowever, nothing in this section shall prohibit an insurer, health maintenance\norganization, health services plan, or optometric services plan from accepting\nany other claims form.\n\nB. No accident and sickness insurer, health maintenance organization, or health\nservices plan licensed in the Commonwealth shall refuse to accept as a standard\nclaims form for hospital services the standardized UB-82 claims form, or its\nsuccessor as it may be amended from time to time. However, nothing in this\nsection shall prohibit an accident and sickness insurer, health maintenance\norganization, or health services plan from accepting any other claims form.\n\nC. No accident and sickness insurer, health maintenance organization, health\nservices plan, or dental services plan licensed in the Commonwealth shall refuse\nto accept as a standard claims form for dental services the standardized ADA\nform prepared by the American Dental Association, or its successor as it may be\namended from time to time. However, nothing in this section shall prohibit an\naccident and sickness insurer, health maintenance organization, health services\nplan, or dental services plan from accepting any other claims form.\n\nD. The forms specified in this section may be modified as necessary to\naccommodate the transmission and administration of claims by electronic means.\n\nE. After July 1, 1998, no health maintenance organization authorized to transact\nbusiness in this Commonwealth and no health insurer, health services plan or\npreferred provider organization authorized to offer health benefits in this\nCommonwealth that requires the use of the Physicians’ Current Procedural\nTerminology (CPT) identifying codes published by the American Medical\nAssociation for reporting claims for medical services and procedures, including\nany standardized form, shall refuse to accept and utilize these identifying\ncodes and any appropriate modifiers listed therein when the same are\nappropriately used for processing such claims for provider services and\nprocedures.\n\nHISTORY: 1993, c. 307; 1997, c. 531.","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}}