2006 Code of Virginia § 32.1-137.14 - Reconsideration of adverse decision

32.1-137.14. Reconsideration of adverse decision.

A. Any reconsideration of an adverse decision shall be requested by theprovider on behalf of the covered person. A decision on reconsideration shallbe made by a physician advisor, peer of the treating health care provider, ora panel of other appropriate health care providers with at least onephysician advisor or peer of the treating health care provider on the panel.

The treating provider on behalf of the covered person shall be notified ofthe determination of the reconsideration of the adverse decision, inaccordance with 32.1-137.9, including the criteria used and the clinicalreason for the adverse decision, the alternate length of treatment of thealternate treatment setting or settings, if any, that the entity deems to beappropriate, and the opportunity for an appeal pursuant to 32.1-137.15.

B. Any reconsideration shall be rendered and the decision provided to thetreating provider and the covered person in writing within ten working daysof receipt of the request for reconsideration.

(1998, c. 891.)