                                 CODE OF VIRGINIA

STANDARDIZED CLAIMS FORMS (§ 38.2-322)

A. 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.

B. 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.

C. 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.

D. The forms specified in this section may be modified as necessary to
accommodate the transmission and administration of claims by electronic means.

E. 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&#8217; 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.

HISTORY: 1993, c. 307; 1997, c. 531.