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Chapter 284-170 WAC

|Show DispositionsLast Update: 11/30/23

HEALTH BENEFIT PLAN MANAGEMENT

WAC Sections

SUBCHAPTER A
GENERAL PROVISIONS
HTMLPDF284-170-110Purpose.
HTMLPDF284-170-120Applicability and scope.
HTMLPDF284-170-125Compliance with state and federal laws.
HTMLPDF284-170-130Definitions.
SUBCHAPTER B
HEALTH CARE NETWORKS
HTMLPDF284-170-200Network accessGeneral standards.
HTMLPDF284-170-210Alternate access delivery request.
HTMLPDF284-170-220Amended alternate access delivery request for services subject to the Balance Billing Protection Act.
HTMLPDF284-170-230Maintenance of sufficient provider networks.
HTMLPDF284-170-240Use of subcontracted networks.
HTMLPDF284-170-260Provider directories.
HTMLPDF284-170-270Every category of health care providers.
HTMLPDF284-170-280Network reportsFormat.
HTMLPDF284-170-285Mental health and substance use disorder web page model format and required content.
HTMLPDF284-170-300Essential community providers for exchange plansDefinition.
HTMLPDF284-170-310Essential community providers for exchange plansNetwork access.
HTMLPDF284-170-320Issuer recordkeepingProvider networks.
HTMLPDF284-170-330Tiered provider networks.
HTMLPDF284-170-340Assessment of access.
HTMLPDF284-170-350Issuer standards for women's right to directly access certain health care practitioners for women's health care services.
HTMLPDF284-170-360Enrollee's access to providers.
HTMLPDF284-170-370Hospital emergency service departments and practice groups.
HTMLPDF284-170-380Standards for temporary substitution of contracted network providers"Locum tenens" providers.
HTMLPDF284-170-390Rule concerning contracted network providers called to active duty military service.
SUBCHAPTER C
PROVIDER CONTRACTS AND PAYMENT
HTMLPDF284-170-401Provider and facility contracts with issuersGenerally.
HTMLPDF284-170-411Selection of participating providersCredentialing and unfair discrimination.
HTMLPDF284-170-421Provider contractsStandardsHold harmless provisions.
HTMLPDF284-170-431Provider contractsTerms and conditions of payment.
HTMLPDF284-170-433Provider contractsTelemedicine.
HTMLPDF284-170-440Provider contractsDispute resolution process.
HTMLPDF284-170-450Pharmacy identification cards.
HTMLPDF284-170-460Provider contractsAudit guidelines.
HTMLPDF284-170-470Pharmacy claimsRejections, notifications and disclosures.
HTMLPDF284-170-480Participating providerFiling and approval.
HTMLPDF284-170-490Effective date.
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