§ 32.1-137.14. Reconsideration of adverse decision
A. Any reconsideration of an adverse decision shall be requested by the provider on behalf of the covered person. A decision on reconsideration shall be made by a physician advisor, peer of the treating health care provider, or a panel of other appropriate health care providers with at least one physician advisor or peer of the treating health care provider on the panel.
The treating provider on behalf of the covered person shall be notified of the determination of the reconsideration of the adverse decision, in accordance with § 32.1-137.9, including the criteria used and the clinical reason for the adverse decision, the alternate length of treatment of the alternate treatment setting or settings, if any, that the entity deems to be appropriate, and the opportunity for an appeal pursuant to § 32.1-137.15.
B. Any reconsideration shall be rendered and the decision provided to the treating provider and the covered person in writing within ten working days of receipt of the request for reconsideration.
(1998, c. 891.)
Sections: Previous 32.1-137.7 32.1-137.8 32.1-137.9 32.1-137.10 32.1-137.11 32.1-137.12 32.1-137.13 32.1-137.14 32.1-137.15 32.1-137.16 32.1-137.17 32.1-138 32.1-138.1 32.1-138.2 32.1-138.3 NextLast modified: April 16, 2009