Managed Care Health Insurance Plan (MCHIP) and Private Review Agents (PRA)

The MCHIP unit within the Acute Care Division is responsible for monitoring compliance with the Rules and Regulations for Certification of Quality Assurance for Managed Care Health Insurance Plan Licensees (12VAC5-408). The unit issues certificates of quality assurance to licensed MCHIPS, conducts onsite compliance reviews, and investigates enrollee complaints regarding the quality of care received from their managed care provider.

The MCHIP unit also issues Certificates of Registration for Private Review Agents (PRAs) and monitors the compliance of these organizations with the Rules Governing Private Review Agents (12VAC5-405).