{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3445.02.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3445.02.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3445.02.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3445.02.html"}],"law_id":74656,"edition_id":1,"section_id":74656,"structure_id":13819,"section_number":"38.2-3445.02","catch_line":"Arbitration","history":"2020, cc. 1080, 1081.","full_text":"A\n\nIf good faith negotiation, as described in § 38.2-3445.01, does not result in resolution of the dispute, and the carrier or the out-of-network provider chooses to pursue further action to resolve the dispute, the carrier or out-of-network provider shall initiate arbitration to determine a commercially reasonable payment amount. To initiate arbitration, the carrier or provider shall provide written notification to the Commission and the noninitiating party no later than 10 calendar days following completion of the period of good faith negotiation provided in § 38.2-3445.01. Such notification shall state the initiating party’s final offer. No later than 30 calendar days following receipt of the notification, the noninitiating party shall provide its final offer to the initiating party. The parties may reach an agreement on reimbursement during this time and before the arbitration proceeding.B\n\nThe parties shall be permitted to bundle claims for arbitration. Multiple claims may be addressed in a single arbitration proceeding if the claims at issue (i) involve identical carrier and provider parties, (ii) involve claims with the same or related current procedural terminology codes relevant to a particular procedure, and (iii) occur within a period of two months of one another.C\n\nWithin seven calendar days of receipt of notification from the initiating party, the Commission shall provide the parties with a list of approved arbitrators or entities that provide arbitrations. The arbitrators on the list shall not have a conflict of interest with the parties and shall be trained and have experience and be selected by the Commission as set out in the standards established by the Commission through regulation. The parties may agree on an arbitrator from the list provided by the Commission. If the parties do not agree on an arbitrator, they shall notify the Commission, and the Commission shall provide the parties with the names of five arbitrators from the list. Each party may veto up to two of the five named arbitrators. If one arbitrator remains, that arbitrator shall be the chosen arbitrator. If more than one arbitrator remains, the Commission shall choose the arbitrator from the remaining arbitrators. The parties and the Commission shall complete this process within 20 calendar days of receipt of the original list from the Commission.D\n\nNo later than 30 days after final selection of the arbitrator pursuant to subsection C, each party shall provide written submissions in support of its position to the arbitrator. The initiating party shall include in its written submission the evidence and methodology for asserting that the amount proposed to be paid is or is not commercially reasonable. A party that fails to make timely written submissions under this subsection without good cause shown shall be considered to be in default, and the arbitrator shall require the defaulting party to pay the final offer of the nondefaulting party and may require the defaulting party to pay the arbitrator’s fixed fee. Written submissions required by this subsection may be submitted electronically.E\n\nNo later than 30 calendar days after the receipt of the parties’ written submissions, the arbitrator shall (i) issue a written decision requiring payment of the final offer amount of either the initiating or noninitiating party, (ii) notify the parties of the decision, and (iii) provide the decision and the information described in subsection I to the Commission.F\n\nIn reviewing the submissions of the parties and making a decision requiring payment of the final offer amount of either the initiating or noninitiating party, the arbitrator shall consider the following factors:1\n\nThe evidence and methodology submitted by the parties to assert that their final offer amount is reasonable; and2\n\nPatient characteristics and the circumstances and complexity of the case, including time and place of service and type of facility, that are not already reflected in the provider’s billing code for the service.\n\t\t\t\tThe arbitrator may also consider other information that a party believes is relevant to the required factors included in this subsection or other information requested by the arbitrator and information provided by the parties that is relevant to such request, including data sets developed pursuant to § 38.2-3445.03. The arbitrator shall not require extrinsic evidence of authenticity for admitting such data sets.G\n\nThe Commission shall establish a schedule of fixed fees for the costs of arbitration. Except as provided in subsection D, such fees shall be divided equally among the parties to the arbitration. The enrollee shall not be liable for any of the costs of arbitration and shall not be required to participate in the arbitration process as a witness or otherwise.H\n\nWithin 10 business days of a party notifying the Commission and the noninitiating party of intent to initiate arbitrations, both parties shall agree to and execute a nondisclosure agreement. The nondisclosure agreement shall not preclude the arbitrator from submitting the arbitrator’s decision to the Commission or impede the Commission’s duty to prepare the annual report required by subsection I.I\n\nThe Commission shall prepare an annual report summarizing the dispute resolution information provided by arbitrators, including information related to the matters decided through arbitration as well as the following information for each dispute resolved through arbitration: the name of the carrier, the name of the health care provider, the health care provider’s employer or the business entity in which the provider has an ownership interest, the health care facility where the services were provided, and the type of health care services at issues. The Commission shall post the report on the Bureau’s website and submit it to the Chairs of the House Committee on Labor and Commerce and Committee on Appropriations and the Senate Committee on Commerce and Labor and Committee on Finance and Appropriations annually by July 1. The provisions of this subsection shall expire on July 1, 2025.J\n\nThe Commission shall establish an appeals process for a party to appeal to the Commission an arbitrator’s decision on the grounds that (i) the decision was substantially influenced by corruption, fraud, or other undue means; (ii) there was evident partiality, corruption, or misconduct prejudicing the rights of any party; (iii) the arbitrator exceeded his powers; or (iv) the arbitrator conducted the proceeding contrary to the provisions of this section and Commission regulations, in such a way as to materially prejudice the rights of the party.K\n\nThe provisions of the Uniform Arbitration Act, Article 2 (§ 8.01-581.01 et seq.) of Chapter 21 of Title 8.01, shall not apply to arbitration proceedings initiated pursuant to this section.","order_by":null,"text":{"0":{"id":268297,"text":"If good faith negotiation, as described in § 38.2-3445.01, does not result in resolution of the dispute, and the carrier or the out-of-network provider chooses to pursue further action to resolve the dispute, the carrier or out-of-network provider shall initiate arbitration to determine a commercially reasonable payment amount. To initiate arbitration, the carrier or provider shall provide written notification to the Commission and the noninitiating party no later than 10 calendar days following completion of the period of good faith negotiation provided in § 38.2-3445.01. Such notification shall state the initiating party’s final offer. No later than 30 calendar days following receipt of the notification, the noninitiating party shall provide its final offer to the initiating party. The parties may reach an agreement on reimbursement during this time and before the arbitration proceeding.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":268298,"text":"The parties shall be permitted to bundle claims for arbitration. Multiple claims may be addressed in a single arbitration proceeding if the claims at issue (i) involve identical carrier and provider parties, (ii) involve claims with the same or related current procedural terminology codes relevant to a particular procedure, and (iii) occur within a period of two months of one another.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":268299,"text":"Within seven calendar days of receipt of notification from the initiating party, the Commission shall provide the parties with a list of approved arbitrators or entities that provide arbitrations. The arbitrators on the list shall not have a conflict of interest with the parties and shall be trained and have experience and be selected by the Commission as set out in the standards established by the Commission through regulation. The parties may agree on an arbitrator from the list provided by the Commission. If the parties do not agree on an arbitrator, they shall notify the Commission, and the Commission shall provide the parties with the names of five arbitrators from the list. Each party may veto up to two of the five named arbitrators. If one arbitrator remains, that arbitrator shall be the chosen arbitrator. If more than one arbitrator remains, the Commission shall choose the arbitrator from the remaining arbitrators. The parties and the Commission shall complete this process within 20 calendar days of receipt of the original list from the Commission.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":268300,"text":"No later than 30 days after final selection of the arbitrator pursuant to subsection C, each party shall provide written submissions in support of its position to the arbitrator. The initiating party shall include in its written submission the evidence and methodology for asserting that the amount proposed to be paid is or is not commercially reasonable. A party that fails to make timely written submissions under this subsection without good cause shown shall be considered to be in default, and the arbitrator shall require the defaulting party to pay the final offer of the nondefaulting party and may require the defaulting party to pay the arbitrator’s fixed fee. Written submissions required by this subsection may be submitted electronically.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":268301,"text":"No later than 30 calendar days after the receipt of the parties’ written submissions, the arbitrator shall (i) issue a written decision requiring payment of the final offer amount of either the initiating or noninitiating party, (ii) notify the parties of the decision, and (iii) provide the decision and the information described in subsection I to the Commission.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":268302,"text":"In reviewing the submissions of the parties and making a decision requiring payment of the final offer amount of either the initiating or noninitiating party, the arbitrator shall consider the following factors:","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"F1"},"6":{"id":268303,"text":"The evidence and methodology submitted by the parties to assert that their final offer amount is reasonable; and","type":"section","prefixes":["F","1"],"prefix":"1","entire_prefix":"F1","prefix_anchor":"F1","level":2,"prior_prefix":"F","next_prefix":"F2"},"7":{"id":268304,"text":"Patient characteristics and the circumstances and complexity of the case, including time and place of service and type of facility, that are not already reflected in the provider’s billing code for the service.\n\t\t\t\tThe arbitrator may also consider other information that a party believes is relevant to the required factors included in this subsection or other information requested by the arbitrator and information provided by the parties that is relevant to such request, including data sets developed pursuant to § 38.2-3445.03. The arbitrator shall not require extrinsic evidence of authenticity for admitting such data sets.","type":"section","prefixes":["F","2"],"prefix":"2","entire_prefix":"F2","prefix_anchor":"F2","level":2,"prior_prefix":"F1","next_prefix":"G"},"8":{"id":268305,"text":"The Commission shall establish a schedule of fixed fees for the costs of arbitration. Except as provided in subsection D, such fees shall be divided equally among the parties to the arbitration. The enrollee shall not be liable for any of the costs of arbitration and shall not be required to participate in the arbitration process as a witness or otherwise.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F2","next_prefix":"H"},"9":{"id":268306,"text":"Within 10 business days of a party notifying the Commission and the noninitiating party of intent to initiate arbitrations, both parties shall agree to and execute a nondisclosure agreement. The nondisclosure agreement shall not preclude the arbitrator from submitting the arbitrator’s decision to the Commission or impede the Commission’s duty to prepare the annual report required by subsection I.","type":"section","prefixes":["H"],"prefix":"H","entire_prefix":"H","prefix_anchor":"H","level":1,"prior_prefix":"G","next_prefix":"I"},"10":{"id":268307,"text":"The Commission shall prepare an annual report summarizing the dispute resolution information provided by arbitrators, including information related to the matters decided through arbitration as well as the following information for each dispute resolved through arbitration: the name of the carrier, the name of the health care provider, the health care provider’s employer or the business entity in which the provider has an ownership interest, the health care facility where the services were provided, and the type of health care services at issues. The Commission shall post the report on the Bureau’s website and submit it to the Chairs of the House Committee on Labor and Commerce and Committee on Appropriations and the Senate Committee on Commerce and Labor and Committee on Finance and Appropriations annually by July 1. The provisions of this subsection shall expire on July 1, 2025.","type":"section","prefixes":["I"],"prefix":"I","entire_prefix":"I","prefix_anchor":"I","level":1,"prior_prefix":"H","next_prefix":"J"},"11":{"id":268308,"text":"The Commission shall establish an appeals process for a party to appeal to the Commission an arbitrator’s decision on the grounds that (i) the decision was substantially influenced by corruption, fraud, or other undue means; (ii) there was evident partiality, corruption, or misconduct prejudicing the rights of any party; (iii) the arbitrator exceeded his powers; or (iv) the arbitrator conducted the proceeding contrary to the provisions of this section and Commission regulations, in such a way as to materially prejudice the rights of the party.","type":"section","prefixes":["J"],"prefix":"J","entire_prefix":"J","prefix_anchor":"J","level":1,"prior_prefix":"I","next_prefix":"K"},"12":{"id":268309,"text":"The provisions of the Uniform Arbitration Act, Article 2 (§ 8.01-581.01 et seq.) of Chapter 21 of Title 8.01, shall not apply to arbitration proceedings initiated pursuant to this section.","type":"section","prefixes":["K"],"prefix":"K","entire_prefix":"K","prefix_anchor":"K","level":1,"prior_prefix":"J"}},"ancestry":[{"id":13819,"edition_id":1,"name":"Federal Market Reforms","identifier":"6","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:45:59","date_modified":"2026-06-26 03:45:59","permalink":{"id":215457,"object_type":"structure","relational_id":13819,"identifier":"6","token":"38.2\/34\/6","url":"\/38.2\/34\/6\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","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":57210,"structure_id":13819,"section_number":"38.2-3438","catch_line":"Definitions","url":"\/38.2-3438\/","token":"38.2\/34\/6\/38.2-3438","metadata":false},{"id":55902,"structure_id":13819,"section_number":"38.2-3439","catch_line":"Dependent coverage for individuals to age 26","url":"\/38.2-3439\/","token":"38.2\/34\/6\/38.2-3439","metadata":false},{"id":59514,"structure_id":13819,"section_number":"38.2-3440","catch_line":"Lifetime and annual limits","url":"\/38.2-3440\/","token":"38.2\/34\/6\/38.2-3440","metadata":false},{"id":74720,"structure_id":13819,"section_number":"38.2-3441","catch_line":"Rescissions","url":"\/38.2-3441\/","token":"38.2\/34\/6\/38.2-3441","metadata":false},{"id":81548,"structure_id":13819,"section_number":"38.2-3442","catch_line":"Preventive services","url":"\/38.2-3442\/","token":"38.2\/34\/6\/38.2-3442","metadata":false},{"id":54833,"structure_id":13819,"section_number":"38.2-3443","catch_line":"Choice of a health care professional","url":"\/38.2-3443\/","token":"38.2\/34\/6\/38.2-3443","metadata":false},{"id":68187,"structure_id":13819,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","url":"\/38.2-3444\/","token":"38.2\/34\/6\/38.2-3444","metadata":false},{"id":60836,"structure_id":13819,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","url":"\/38.2-3445\/","token":"38.2\/34\/6\/38.2-3445","metadata":false},{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},{"id":74656,"structure_id":13819,"section_number":"38.2-3445.02","catch_line":"Arbitration","url":"\/38.2-3445.02\/","token":"38.2\/34\/6\/38.2-3445.02","metadata":false},{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},{"id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","metadata":false},{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},{"id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","metadata":false},{"id":72898,"structure_id":13819,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","url":"\/38.2-3445.07\/","token":"38.2\/34\/6\/38.2-3445.07","metadata":false},{"id":68114,"structure_id":13819,"section_number":"38.2-3445.1","catch_line":"Repealed","url":"\/38.2-3445.1\/","token":"38.2\/34\/6\/38.2-3445.1","metadata":false},{"id":63588,"structure_id":13819,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; reporting requirements","url":"\/38.2-3445.2\/","token":"38.2\/34\/6\/38.2-3445.2","metadata":false},{"id":86937,"structure_id":13819,"section_number":"38.2-3446","catch_line":"Applicability of federal law","url":"\/38.2-3446\/","token":"38.2\/34\/6\/38.2-3446","metadata":false},{"id":66501,"structure_id":13819,"section_number":"38.2-3447","catch_line":"(Effective January 1, 2026) Restrictions relating to premium rates","url":"\/38.2-3447\/","token":"38.2\/34\/6\/38.2-3447","metadata":false},{"id":79799,"structure_id":13819,"section_number":"38.2-3448","catch_line":"Guaranteed availability","url":"\/38.2-3448\/","token":"38.2\/34\/6\/38.2-3448","metadata":false},{"id":78815,"structure_id":13819,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","url":"\/38.2-3449\/","token":"38.2\/34\/6\/38.2-3449","metadata":false},{"id":67706,"structure_id":13819,"section_number":"38.2-3449.1","catch_line":"Prohibited discrimination based on gender identity or status as a transgender individual","url":"\/38.2-3449.1\/","token":"38.2\/34\/6\/38.2-3449.1","metadata":false},{"id":64622,"structure_id":13819,"section_number":"38.2-3450","catch_line":"Genetic information and testing","url":"\/38.2-3450\/","token":"38.2\/34\/6\/38.2-3450","metadata":false},{"id":83154,"structure_id":13819,"section_number":"38.2-3451","catch_line":"Essential health benefits","url":"\/38.2-3451\/","token":"38.2\/34\/6\/38.2-3451","metadata":false},{"id":76537,"structure_id":13819,"section_number":"38.2-3452","catch_line":"Waiting periods","url":"\/38.2-3452\/","token":"38.2\/34\/6\/38.2-3452","metadata":false},{"id":86395,"structure_id":13819,"section_number":"38.2-3453","catch_line":"Clinical trials","url":"\/38.2-3453\/","token":"38.2\/34\/6\/38.2-3453","metadata":false},{"id":81951,"structure_id":13819,"section_number":"38.2-3454","catch_line":"Wellness programs","url":"\/38.2-3454\/","token":"38.2\/34\/6\/38.2-3454","metadata":false},{"id":84250,"structure_id":13819,"section_number":"38.2-3454.1","catch_line":"Renewal of health benefit plans; special exception","url":"\/38.2-3454.1\/","token":"38.2\/34\/6\/38.2-3454.1","metadata":false}],"previous_section":{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},"next_section":{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3445.02\/","history_text":"

This law was first created in 2020. The record of its establishment is cataloged in chapters 1080<\/a> and 1081<\/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.<\/p>","references":[{"id":67926,"section_number":"38.2-3445.05","catch_line":"Enforcement","order_by":null,"url":"\/38.2-3445.05\/"},{"id":66467,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","order_by":null,"url":"\/38.2-3445.06\/"},{"id":72898,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","order_by":null,"url":"\/38.2-3445.07\/"}],"refers_to":[{"id":57195,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","order_by":null,"url":"\/38.2-3445.01\/"},{"id":57491,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","order_by":null,"url":"\/38.2-3445.03\/"},{"id":77939,"section_number":"8.01-581.01","catch_line":"Validity of arbitration agreement","order_by":null,"url":"\/8.01-581.01\/"}],"permalink":{"id":215495,"object_type":"law","relational_id":74656,"identifier":"38.2-3445.02","token":"38.2\/34\/6\/38.2-3445.02","url":"\/38.2-3445.02\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3445.02\/","token":"38.2\/34\/6\/38.2-3445.02","dublin_core":{"Title":"Arbitration","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3445.02","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> If good faith negotiation, as described in § 38.2-3445.01<\/a>, does not result in resolution of the dispute, and the carrier or the out-of-network provider chooses to pursue further action to resolve the dispute, the carrier or out-of-network provider shall initiate arbitration to determine a commercially reasonable payment amount. To initiate arbitration, the carrier or provider shall provide written notification to the Commission<\/span> and the noninitiating party<\/span> no later than 10 calendar days following completion of the period of good faith negotiation provided in § 38.2-3445.01<\/a>. Such notification shall state<\/span> the initiating party<\/span>’s final offer. No later than 30 calendar days following receipt of the notification, the noninitiating party<\/span> shall provide its final offer to the initiating party<\/span>. The parties may reach an agreement on reimbursement during this time and before the arbitration proceeding. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The parties shall be permitted to bundle claims for arbitration. Multiple claims may be addressed in a single arbitration proceeding if the claims at issue<\/span> (i) involve identical carrier and provider parties, (ii) involve claims with the same or related current procedural terminology codes relevant to a particular procedure, and (iii) occur within a period of two months of one another. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Within seven calendar days of receipt of notification from the initiating party<\/span>, the Commission<\/span> shall provide the parties with a list of approved arbitrators or entities that provide arbitrations. The arbitrators on the list shall not have a conflict of interest<\/span> with the parties and shall be trained and have experience and be selected by the Commission<\/span> as set out in the standards established by the Commission<\/span> through regulation. The parties may agree on an arbitrator from the list provided by the Commission<\/span>. If the parties do not agree on an arbitrator, they shall notify the Commission<\/span>, and the Commission<\/span> shall provide the parties with the names of five arbitrators from the list. Each party<\/span> may veto up to two of the five named arbitrators. If one arbitrator remains, that arbitrator shall be the chosen arbitrator. If more than one arbitrator remains, the Commission<\/span> shall choose the arbitrator from the remaining arbitrators. The parties and the Commission<\/span> shall complete this process within 20 calendar days of receipt of the original list from the Commission<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> No later than 30 days after final selection of the arbitrator pursuant to subsection C, each party<\/span> shall provide written submissions in support of its position to the arbitrator. The initiating party<\/span> shall include in its written submission the evidence<\/span> and methodology for asserting that the amount proposed to be paid is or is not commercially reasonable. A party<\/span> that fails to make timely written submissions under this subsection without good cause shown shall be considered to be in default<\/span>, and the arbitrator shall require the defaulting party<\/span> to pay the final offer of the nondefaulting party<\/span> and may require the defaulting party<\/span> to pay the arbitrator’s fixed fee. Written submissions required by this subsection may be submitted electronically. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> No later than 30 calendar days after the receipt of the parties’ written submissions, the arbitrator shall (i) issue<\/span> a written decision requiring payment of the final offer amount of either the initiating or noninitiating party<\/span>, (ii) notify the parties of the decision, and (iii) provide the decision and the information described in subsection I to the Commission<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> In reviewing the submissions of the parties and making a decision requiring payment of the final offer amount of either the initiating or noninitiating party<\/span>, the arbitrator shall consider the following factors: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The evidence<\/span> and methodology submitted by the parties to assert that their final offer amount is reasonable; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Patient characteristics and the circumstances and complexity of the case, including time and place of service and type of facility, that are not already reflected in the provider’s billing code for the service.\n\t\t\t\tThe arbitrator may also consider other information that a party<\/span> believes is relevant to the required factors included in this subsection or other information requested by the arbitrator and information provided by the parties that is relevant to such request, including data sets developed pursuant to § 38.2-3445.03<\/a>. The arbitrator shall not require extrinsic evidence<\/span> of authenticity for admitting such data sets. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> The Commission<\/span> shall establish a schedule of fixed fees for the costs of arbitration. Except as provided in subsection D, such fees shall be divided equally among the parties to the arbitration. The enrollee shall not be liable for any of the costs of arbitration and shall not be required to participate in the arbitration process as a witness<\/span> or otherwise. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

H.<\/span> Within 10 business days of a party<\/span> notifying the Commission<\/span> and the noninitiating party<\/span> of intent<\/span> to initiate arbitrations, both parties shall agree to and execute a nondisclosure agreement. The nondisclosure agreement shall not preclude the arbitrator from submitting the arbitrator’s decision to the Commission<\/span> or impede the Commission<\/span>’s duty to prepare the annual report required by subsection I. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

I.<\/span> The Commission<\/span> shall prepare an annual report summarizing the dispute resolution information provided by arbitrators, including information related to the matters decided through arbitration as well as the following information for each dispute resolved through arbitration: the name of the carrier, the name of the health care provider, the health care provider’s employer or the business entity in which the provider has an ownership interest, the health care facility where the services were provided, and the type of health care services at issues<\/span>. The Commission<\/span> shall post the report on the Bureau<\/span>’s website and submit it to the Chairs of the House Committee on Labor and Commerce and Committee on Appropriations and the Senate Committee on Commerce and Labor and Committee on Finance and Appropriations annually by July 1. The provisions of this subsection shall expire on July 1, 2025. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

J.<\/span> The Commission<\/span> shall establish an appeals<\/span> process for a party<\/span> to appeal<\/span> to the Commission<\/span> an arbitrator’s decision on the grounds that (i) the decision was substantially influenced by corruption, fraud<\/span>, or other undue means; (ii) there was evident partiality, corruption, or misconduct prejudicing the rights of any party<\/span>; (iii) the arbitrator exceeded his powers; or (iv) the arbitrator conducted the proceeding contrary to the provisions of this section and Commission<\/span> regulations, in such a way as to materially prejudice the rights of the party<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

K.<\/span> The provisions of the Uniform Arbitration Act, Article 2 (§ 8.01-581.01<\/a> et seq.) of Chapter 21 of Title 8.01, shall not apply to arbitration proceedings initiated pursuant to this section. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nARBITRATION (\u00a7 38.2-3445.02)\n\nA. If good faith negotiation, as described in § 38.2-3445.01, does not\nresult in resolution of the dispute, and the carrier or the out-of-network\nprovider chooses to pursue further action to resolve the dispute, the carrier or\nout-of-network provider shall initiate arbitration to determine a commercially\nreasonable payment amount. To initiate arbitration, the carrier or provider\nshall provide written notification to the Commission and the noninitiating party\nno later than 10 calendar days following completion of the period of good faith\nnegotiation provided in § 38.2-3445.01. Such notification shall state the\ninitiating party’s final offer. No later than 30 calendar days following\nreceipt of the notification, the noninitiating party shall provide its final\noffer to the initiating party. The parties may reach an agreement on\nreimbursement during this time and before the arbitration proceeding.\n\nB. The parties shall be permitted to bundle claims for arbitration. Multiple\nclaims may be addressed in a single arbitration proceeding if the claims at\nissue (i) involve identical carrier and provider parties, (ii) involve claims\nwith the same or related current procedural terminology codes relevant to a\nparticular procedure, and (iii) occur within a period of two months of one\nanother.\n\nC. Within seven calendar days of receipt of notification from the initiating\nparty, the Commission shall provide the parties with a list of approved\narbitrators or entities that provide arbitrations. The arbitrators on the list\nshall not have a conflict of interest with the parties and shall be trained and\nhave experience and be selected by the Commission as set out in the standards\nestablished by the Commission through regulation. The parties may agree on an\narbitrator from the list provided by the Commission. If the parties do not agree\non an arbitrator, they shall notify the Commission, and the Commission shall\nprovide the parties with the names of five arbitrators from the list. Each party\nmay veto up to two of the five named arbitrators. If one arbitrator remains,\nthat arbitrator shall be the chosen arbitrator. If more than one arbitrator\nremains, the Commission shall choose the arbitrator from the remaining\narbitrators. The parties and the Commission shall complete this process within\n20 calendar days of receipt of the original list from the Commission.\n\nD. No later than 30 days after final selection of the arbitrator pursuant to\nsubsection C, each party shall provide written submissions in support of its\nposition to the arbitrator. The initiating party shall include in its written\nsubmission the evidence and methodology for asserting that the amount proposed\nto be paid is or is not commercially reasonable. A party that fails to make\ntimely written submissions under this subsection without good cause shown shall\nbe considered to be in default, and the arbitrator shall require the defaulting\nparty to pay the final offer of the nondefaulting party and may require the\ndefaulting party to pay the arbitrator’s fixed fee. Written submissions\nrequired by this subsection may be submitted electronically.\n\nE. No later than 30 calendar days after the receipt of the parties’\nwritten submissions, the arbitrator shall (i) issue a written decision requiring\npayment of the final offer amount of either the initiating or noninitiating\nparty, (ii) notify the parties of the decision, and (iii) provide the decision\nand the information described in subsection I to the Commission.\n\nF. In reviewing the submissions of the parties and making a decision requiring\npayment of the final offer amount of either the initiating or noninitiating\nparty, the arbitrator shall consider the following factors:\n\n 1. The evidence and methodology submitted by the parties to assert that their\n final offer amount is reasonable; and\n\n 2. Patient characteristics and the circumstances and complexity of the case,\n including time and place of service and type of facility, that are not already\n reflected in the provider’s billing code for the service.\n \t\t\t\tThe arbitrator may also consider other information that a party believes\n is relevant to the required factors included in this subsection or other\n information requested by the arbitrator and information provided by the\n parties that is relevant to such request, including data sets developed\n pursuant to § 38.2-3445.03. The arbitrator shall not require extrinsic\n evidence of authenticity for admitting such data sets.\n\nG. The Commission shall establish a schedule of fixed fees for the costs of\narbitration. Except as provided in subsection D, such fees shall be divided\nequally among the parties to the arbitration. The enrollee shall not be liable\nfor any of the costs of arbitration and shall not be required to participate in\nthe arbitration process as a witness or otherwise.\n\nH. Within 10 business days of a party notifying the Commission and the\nnoninitiating party of intent to initiate arbitrations, both parties shall agree\nto and execute a nondisclosure agreement. The nondisclosure agreement shall not\npreclude the arbitrator from submitting the arbitrator’s decision to the\nCommission or impede the Commission’s duty to prepare the annual report\nrequired by subsection I.\n\nI. The Commission shall prepare an annual report summarizing the dispute\nresolution information provided by arbitrators, including information related to\nthe matters decided through arbitration as well as the following information for\neach dispute resolved through arbitration: the name of the carrier, the name of\nthe health care provider, the health care provider’s employer or the\nbusiness entity in which the provider has an ownership interest, the health care\nfacility where the services were provided, and the type of health care services\nat issues. The Commission shall post the report on the Bureau’s website\nand submit it to the Chairs of the House Committee on Labor and Commerce and\nCommittee on Appropriations and the Senate Committee on Commerce and Labor and\nCommittee on Finance and Appropriations annually by July 1. The provisions of\nthis subsection shall expire on July 1, 2025.\n\nJ. The Commission shall establish an appeals process for a party to appeal to\nthe Commission an arbitrator’s decision on the grounds that (i) the\ndecision was substantially influenced by corruption, fraud, or other undue\nmeans; (ii) there was evident partiality, corruption, or misconduct prejudicing\nthe rights of any party; (iii) the arbitrator exceeded his powers; or (iv) the\narbitrator conducted the proceeding contrary to the provisions of this section\nand Commission regulations, in such a way as to materially prejudice the rights\nof the party.\n\nK. The provisions of the Uniform Arbitration Act, Article 2 (§ 8.01-581.01\net seq.) of Chapter 21 of Title 8.01, shall not apply to arbitration proceedings\ninitiated pursuant to this section.\n\nHISTORY: 2020, cc. 1080, 1081.","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}}