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The Bureau of Insurance administers the arbitration process for balance billing claim disputes between carriers and providers. In response to a determination that certain provider groups are filing arbitration requests with such frequency as to indicate a general business practice in violation of § 38.2-3445.05 D of the Code of Virginia, the Bureau issued Administrative Letter 2021-04.

In Administrative Letter 2021-04, the Bureau (i) set a standard of no more than one arbitration request per provider group during a seven day period regardless of geographic area, CPT code, or carrier involved (but bundling of claims in accordance with established rules is allowed); (ii) reminded parties involved in payment disputes to engage in good faith negotiations as required by § 38.2-3445.01 F; and (iii) reminded carriers to pay a commercially reasonable amount as required in § 38.2-34405.01 F.

In addition, the Bureau recommended that carriers and providers consider the results of previous arbitration decisions and adjust the payment offer during negotiations as appropriate.