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 114-58-12 - Exemption from External Review Requirements
Universal Citation: 114 WV Code of State Rules 114-58-12
Current through Register Vol. XLI, No. 38, September 20, 2024
12.1. Upon written application to and approval by the commissioner a managed care plan may be exempted from the requirements for external review as specified in W. Va. Code '33-25C-6 upon a showing that:
a. The managed care plan has an established
external review procedure in place;
b.
The managed care plan has been reviewed by and maintains a current full
accreditation from a nationally recognized accreditation and review organization
approved by the commissioner, in accordance with W. Va. Code '33-25A-17a; and
c. As part of the accreditation
process, the accreditation and review organization reviewed and approved the managed
care plan's external review process.
12.2. The managed care plan shall immediately notify the commissioner upon any loss of accreditation or upon any corrective plan of action made or suggested to the plan's external review process by the accreditation and review organization.
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