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Chapter 284-170 WAC

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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 access—General standards.
HTMLPDF284-170-210Alternate access delivery request.
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 reports—Format.
HTMLPDF284-170-300Essential community providers for exchange plans—Definition.
HTMLPDF284-170-310Essential community providers for exchange plans—Network access.
HTMLPDF284-170-320Issuer recordkeeping—Provider 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 issuers—Generally.
HTMLPDF284-170-411Selection of participating providers—Credentialing and unfair discrimination.
HTMLPDF284-170-421Provider contracts—Standards—Hold harmless provisions.
HTMLPDF284-170-431Provider contracts—Terms and conditions of payment.
HTMLPDF284-170-440Provider contracts—Dispute resolution process.
HTMLPDF284-170-450Pharmacy identification cards.
HTMLPDF284-170-460Provider contracts—Audit guidelines.
HTMLPDF284-170-470Pharmacy claims—Rejections, notifications and disclosures.
HTMLPDF284-170-480Participating provider—Filing and approval.
HTMLPDF284-170-490Effective date.
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