Ambulatory Patient Services (EHB) (Cont’d) Internal appeals 42 U.S.C. Does the plan have a fully operational, comprehensive process for review of Appeals / review of §300gg-19 (a) appeals / adverse benefit determinations? Procedures adverse benefit 45 C.F.R. decisions §147.136(b) Resources: ; Both Grand- RCW 48.43.530(1) fathered and WAC Non-Grand- plans
Ambulatory Patient Services (EHB) (Cont’d) Appeals Procedures Resources: ; Internal appeals / review of adverse benefit decisions Both and plans 42 U.S.C. §300gg-19 (a) 45 C.F.R. §147.136(b) RCW 48.43.530(1) WAC Does the plan have a fully operational, comprehensive process for review of appeals / adverse benefit determinations? Non-Grand- fathered Grand-
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