West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-58 - External Review Of Coverage Denials
Section 114-58-1 - General
Universal Citation: 114 WV Code of State Rules 114-58-1
Current through Register Vol. XLI, No. 38, September 20, 2024
1.1. Scope. -- The purpose of this rule is to provide standards for the external review process set forth in W. Va. Code '33-25C-6, including the procedures for selection of and assignment of external review organizations.
a. Except as otherwise provided,
this rule applies to:
1. Health maintenance
organizations and prepaid limited health service organizations; and
2. External review organizations seeking approval
by the commissioner to conduct external reviews on behalf of managed care
plans.
b. This rule does not
apply to:
1. Coverage provided by managed care
plans to medicaid recipients under W. Va. Code '33-25A-27;
2. Coverage provided by managed care plans to
beneficiaries enrolled in medicare programs operated under Title XVIII of the Social
Security Act, 42 Stat. 620 (1935), 42 U.S.C. '1851, as amended; or
3. Workers' compensation insurance under W. Va.
Code ''23-2-1 et seq.
1.2. Authority. -- W. Va. Code ''33-2-10 , 33-25C-6 and 33-25C-9.
1.3. Filing Date. -- April 8, 2002.
1.4. Effective Date. -- July 1, 2002.
Disclaimer: These regulations may not be the most recent version. West Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
