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
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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
45 CFR § 146.130 (a)
January 22, 2025 12:43 am(a) Hospital length of stay—(1) General rule. Except as provided in paragraph (a)(5) of this section, a group health plan,... View more
RCW 48.43.115 (3)
January 22, 2025 12:43 am(3)(a) Every health carrier that provides coverage for maternity services must permit the attending provider, in consultation with the mother,... View more
RCW 48.43.041 (1)(a)
January 22, 2025 12:42 am(a) Maternity services that include, with no enrollee cost-sharing requirements beyond those generally applicable cost-sharing requirements: Diagnosis of pregnancy; prenatal... View more
WAC 284-170-431 (2)(d)
January 22, 2025 12:40 amAny carrier failing to pay claims within the standard established under subsection (2) of this section shall pay interest on... View more
WAC 284-43-2050 (10)(a)(i-ii)
January 22, 2025 12:39 am(10) The time frames for carrier prior authorization determination and notification to a participating provider or facility are as follows:... View more
WA HMO Appeal – Untimely Payment
January 22, 2025 12:15 amURGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Office... View more