Virginia Administrative Code
Title 14 - INSURANCE
Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE
Chapter 216 - RULES GOVERNING INTERNAL APPEAL AND EXTERNAL REVIEW
Part III - External Review
Form - FORMS (14VAC5-216)
Universal Citation: 14 VA Admin Code
Current through Register Vol. 41, No. 3, September 23, 2024
External Review Request Form, Form 216-A (7/11).
Appointment of Authorized Representative, Form 216-B (7/11).
Physician Certification Expedited External Review Request, Form 216-C (7/11).
Physician Certification Experimental or Investigational Denials, Form 216-D (7/11).
Independent Review Organization Application for Registration, Form 216-E (7/11).
Health Carrier External Review Annual Report Form, Form 216-F (7/11).
Independent Review Organization External Review Annual Report Form, Form 216-G (7/11).
Self-Insured Plan Opt-In to Virginia External Review Process, Form 216-H (7/11).
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