Chapter 284-170 WAC

Last Update: 9/20/16

HEALTH BENEFIT PLAN MANAGEMENT

WAC Sections

SUBCHAPTER A
GENERAL PROVISIONS
284-170-110Purpose.
284-170-120Applicability and scope.
284-170-125Compliance with state and federal laws.
284-170-130Definitions.
SUBCHAPTER B
HEALTH CARE NETWORKS
284-170-200Network access—General standards.
284-170-210Alternate access delivery request.
284-170-230Maintenance of sufficient provider networks.
284-170-240Use of subcontracted networks.
284-170-260Provider directories.
284-170-270Every category of health care providers.
284-170-280Network reports—Format.
284-170-300Essential community providers for exchange plans—Definition.
284-170-310Essential community providers for exchange plans—Network access.
284-170-320Issuer recordkeeping—Provider networks.
284-170-330Tiered provider networks.
284-170-340Assessment of access.
284-170-350Issuer standards for women's right to directly access certain health care practitioners for women's health care services.
284-170-360Enrollee's access to providers.
284-170-370Hospital emergency service departments and practice groups.
284-170-380Standards for temporary substitution of contracted network providers—"Locum tenens" providers.
284-170-390Rule concerning contracted network providers called to active duty military service.
SUBCHAPTER C
PROVIDER CONTRACTS AND PAYMENT
284-170-401Provider and facility contracts with issuers—Generally.
284-170-411Selection of participating providers—Credentialing and unfair discrimination.
284-170-421Provider contracts—Standards—Hold harmless provisions.
284-170-431Provider contracts—Terms and conditions of payment.
284-170-440Provider contracts—Dispute resolution process.
284-170-450Pharmacy identification cards.
284-170-460Provider contracts—Audit guidelines.
284-170-470Pharmacy claims—Rejections, notifications and disclosures.
284-170-480Participating provider—Filing and approval.
284-170-490Effective date.
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