Legal & Mandates
- 2015 ACA Rate Increase Justification
- Patient Rights & Responsibilities
- Health Care Fraud Prevention
- Quality Improvement
- Mental Health Parity
- MD Proposed Rate Increase Law
- Virginia Claims or Coverage Denials
- Machine Readable Data
Virginia Claims or Coverage Denials
Obtain Forms to Request External Review of Claims after receiving an Adverse Benefit Determination
CareFirst Virigina Members may request an external review of any denied claims or coverage by the Virginia State Corporation Commission.
If you have CareFirst health insurance in Virginia, you may visit the Virginia State Corporation Commission website to obtain forms and resources to submit a request for an external review on claim and coverage denials occurring after July 1, 2011.
Details on what types of coverage and adverse benefit determinations are eligible for this request, as well as information on how to make the request, are located on the Virginia State Corporation Commission website.