Last Update: 9/20/16

Chapter 284-170 WAC

HEALTH BENEFIT PLAN MANAGEMENT

WAC Sections

SUBCHAPTER A
GENERAL PROVISIONS
Purpose.
Applicability and scope.
Compliance with state and federal laws.
Definitions.
SUBCHAPTER B
HEALTH CARE NETWORKS
Network accessGeneral standards.
Alternate access delivery request.
Maintenance of sufficient provider networks.
Use of subcontracted networks.
Provider directories.
Every category of health care providers.
Network reportsFormat.
Essential community providers for exchange plansDefinition.
Essential community providers for exchange plansNetwork access.
Issuer recordkeepingProvider networks.
Tiered provider networks.
Assessment of access.
Issuer standards for women's right to directly access certain health care practitioners for women's health care services.
Enrollee's access to providers.
Hospital emergency service departments and practice groups.
Standards for temporary substitution of contracted network providers"Locum tenens" providers.
Rule concerning contracted network providers called to active duty military service.
SUBCHAPTER C
PROVIDER CONTRACTS AND PAYMENT
Provider and facility contracts with issuersGenerally.
Selection of participating providersCredentialing and unfair discrimination.
Provider contractsStandardsHold harmless provisions.
Provider contractsTerms and conditions of payment.
Provider contractsDispute resolution process.
Pharmacy identification cards.
Provider contractsAudit guidelines.
Pharmacy claimsRejections, notifications and disclosures.
Participating providerFiling and approval.
Effective date.
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