• Date Due: December 01, 2022
  • Author: State Corporation Commission
  • Enabling Authority: Code of Virginia - § 38.2-3445.2 (C.)
  • Description:
    Annual report on (i) the number of out-of-network claims for services described in subsection A of § 38.2-3445.01 of the Code of Virginia for the previous fiscal year; (ii) the number and identity of health care providers in the health carrier's network of emergency services providers and surgical or ancillary services providers whose participation in the network was terminated by the health carrier or the health care provider in the previous year and whether participation was subsequently reinstated in the same year; (iii) a summary of the stated reasons for terminating participation; (iv) a summary of the nature and extent of differences in payment levels prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination; (v) an assessment by the Bureau of the potential impact of any changes in network participation or payment levels for emergency services on health insurance premiums in the time period to which the report applies; and (vi) the number and type of claims resolved by arbitration and aggregate information on the disposition of those arbitrations, including in which category group's favor the dispute was resolved, and aggregate information on the variation between the initial payment and final settlement amounts. [Reporting requirements of Chapter 1080, Enactment Clause 6., of the 2020 Acts of Assembly, are identical.]