                                 CODE OF VIRGINIA

EXTERNAL REVIEW REPORTING REQUIREMENTS (§ 38.2-3568)

A. An independent review organization shall maintain written records, in the
aggregate by state and by health carrier, on all external review requests and
external reviews conducted during each calendar year. Each independent review
organization shall submit a report to the Commission. The report shall be
submitted to the Commission by April 1 of the following calendar year. The
report shall include in the aggregate by state, and for each health carrier: the
total number of requests for external review; the number of requests for
external review resolved and, of those resolved, the number upholding the
adverse determination or final adverse determination, and the number reversing
the adverse determination or final adverse determination; the average length of
time for resolution; a summary of the types of coverages or cases for which an
external review was sought; the number of external reviews that were terminated
as the result of a reconsideration by the health carrier; and any other
information the Commission may request or require. The independent review
organization shall retain required written records for at least three years.

B. Each health carrier shall maintain written records, in the aggregate by state
and for each type of health benefit plan offered, on all requests for external
review. Each health carrier shall submit a report to the Commission. The report
shall be submitted to the Commission by April 1 of the following calendar year.
The report shall include in the aggregate by state, and by type of health
benefit plan: the total number of requests for external review, the number of
requests determined eligible for external review, the number of external reviews
completed, and any other information the Commission may request or require. The
health carrier shall retain required written record for at least three years.

HISTORY: 2011, c. 788.