# 14 Va. Admin. Code § 5-216-60: 14VAC5-216-60. Concurrent review decisions

> Virginia · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_60

## Section

- **Citation:** 14 Va. Admin. Code § 5-216-60
- **Heading:** 14VAC5-216-60. Concurrent review decisions
- **Jurisdiction:** Virginia
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Virginia Administrative Code / Title 14 Insurance / Agency 5 State Corporation Commission, Bureau of Insurance / Chapter 216 / 14VAC5-216-60

## Text

A. A health carrier shall provide continued coverage pending the outcome of an internal appeal of a concurrent review decision.
B. Any reduction or termination by a health carrier of an approved course of treatment (other than by health benefit plan amendment or termination) to be provided over a period of time or number of treatments shall constitute an adverse benefit determination. The health carrier shall notify the covered person of the adverse benefit determination at a time sufficiently in advance of the reduction or termination to allow the covered person to file an internal appeal and obtain a determination before the benefit is reduced or terminated.
C. Any request by a covered person to extend the course of treatment beyond the period of time or number of treatments that is an urgent care appeal shall be decided as soon as possible, taking into account the medical exigencies. The covered person and the treating health care professional shall be notified of the benefit determination within 72 hours after receipt of the internal appeal.

## Nearby sections

- [14 Va. Admin. Code § 5-216-10 14VAC5-216-10. Scope and purpose](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_10.md)
- [14 Va. Admin. Code § 5-216-20 14VAC5-216-20. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_20.md)
- [14 Va. Admin. Code § 5-216-30 14VAC5-216-30. General requirements](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_30.md)
- [14 Va. Admin. Code § 5-216-40 14VAC5-216-40. Minimum appeal requirements](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_40.md)
- [14 Va. Admin. Code § 5-216-45 14VAC5-216-45. Exhaustion](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_45.md)
- [14 Va. Admin. Code § 5-216-50 14VAC5-216-50. Urgent care appeals](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_50.md)
- [14 Va. Admin. Code § 5-216-60 14VAC5-216-60. Concurrent review decisions](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_60.md)
- [14 Va. Admin. Code § 5-216-65 14VAC5-216-65. Exception request for prescription drugs](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_65.md)
- [14 Va. Admin. Code § 5-216-70 14VAC5-216-70. Notification requirements](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_70.md)
- [14 Va. Admin. Code § 5-216-80 14VAC5-216-80. Incomplete or ineligible determinations](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_80.md)
- [14 Va. Admin. Code § 5-216-90 14VAC5-216-90. Expedited external review](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_90.md)
- [14 Va. Admin. Code § 5-216-100 14VAC5-216-100. Qualifications for independent review organizations](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_100.md)
- [14 Va. Admin. Code § 5-216-110 14VAC5-216-110. External review reporting requirements](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_110.md)
- [14 Va. Admin. Code § 5-216-120 14VAC5-216-120. Funding of external review](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_120.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_14_5_216_60. Check the current official text before relying on it. Not legal advice.