§ 32-1-138-9

Each private review agent shall file an application with the Department which shall meet the following minimum standards and any additional standards established by regulation pursuant to § 32.1-138.15, and pay a filing fee established by the Department, in order to be approved by the Department:\n1. A description of the procedures to be used in evaluating proposed or delivered hospital, medical, or other health care services;\n2. The procedures by which patients or providers may seek reconsideration of determinations by private review agents;\n3. The type and qualifications of the personnel either employed or under contract to perform the utilization review;\n4. Procedures and policies which ensure that patient-specific medical records and information shall be kept strictly confidential except as authorized by the patient or by regulations adopted pursuant to this article; and\n5. Assurances that reviewers be readily accessible by telephone to patients and providers at least forty hours per week during normal business hours.\n1990, c. 826, § 38.2-5302; 1998, c. 129.