WAC 284-170-431
January 22, 2025 12:58 am(2)(a) For health services provided to covered persons, a carrier shall pay providers and facilities as soon as practical but... View more
Archives
RCW 48.43.093 (d)
January 22, 2025 12:56 am(d) If a health carrier requires preauthorization for post evaluation or post stabilization services, the health carrier shall provide access... View more
RCW 48.43.093 (1)(b)
January 22, 2025 12:54 am(b) If an authorized representative of a health carrier authorizes coverage of emergency services, the health carrier shall not subsequently... View more
RCW 48.43.525 (1)
January 22, 2025 12:54 am(1) A health carrier that offers a health plan shall not retrospectively deny coverage for emergency and nonemergency care that... View more
RCW 48.43.600 (1-3)
January 22, 2025 12:51 am(1) Except in the case of fraud, or as provided in subsections (2) and (3) of this section, a carrier... View more
WAC 284-43-3070 (1-2, 4-8)
January 22, 2025 12:48 am(1) A carrier must notify enrollees of an adverse benefit determination either electronically or by U.S. mail. The notification must... View more
WAC 284-43-2000 (7)(c)(ii)
January 22, 2025 12:47 am(ii) Whenever there is an adverse determination the issuer must notify the provider or facility and the enrollee. The issuer... View more
WAC 284-170-431 (e)(4)
January 22, 2025 12:46 am(4) Denial of a claim must be communicated to the provider or facility and must include the specific reason why... View more
RCW 48.43.093 (1)(a)
January 22, 2025 12:45 am(a) A health carrier shall cover emergency services necessary to screen and stabilize a covered person if a prudent layperson... View more
WAC 284-43-3110 (6)
January 22, 2025 12:44 amReview of adverse determinations must be performed by health care providers or staff who were not involved in the initial... View more