Provider Participating RCW 48.44.010(14) “Participating provider” must be defined (whether or not this Requirements Provider definition is set in the policy) consistent with the statutory and Definition regulatory definitions: "’Participating provider’ means a provider, who or which has contracted in writing with a health care service contractor to accept payment from and to look solely to such contractor according to the terms of the subscriber contract for any health care services rendered to a person who has previously paid, or on whose behalf prepayment has been made, to such contractor for such services.” Provider Coverage for RCW 48.44.290 Issuer must not deny benefits for services performed by a Requirements Services by registered or advanced registered nurse under Chapter RCW if (Cont’d) RN or ARNP the service performed was within the lawful scope of their license, and the contract would have provided benefits if the service had been performed by a licensee under Chapter RCW. Restorative Required WAC Plan must cover restorative care in a manner substantially equal to the Services Services See, also, base benchmark plan, including at least the following services: WAC 284-43-5702(6). WAC Plan must cover composite and amalgam restorations (fillings) on Benchmark the same tooth every two years. plan Benchmark Allowable plan Plan may limit restorations to the following: limitations Maximum of five surfaces per tooth for permanent posterior teeth, except for upper molars; Maximum of six surfaces per tooth for teeth one, two, three, 14, 15 and 16; Maximum of six surfaces per for permanent anterior teeth; and
Provider Requirements Provider Requirements (Cont’d) Participating Provider Definition RCW 48.44.010(14) “Participating provider” must be defined (whether or not this definition is set in the policy) consistent with the statutory and regulatory definitions: "’Participating provider’ means a provider, who or which has contracted in writing with a health care service contractor to accept payment from and to look solely to such contractor according to the terms of the subscriber contract for any health care services rendered to a person who has previously paid, or on whose behalf prepayment has been made, to such contractor for such services.” Coverage for Services by RN or ARNP RCW 48.44.290 Issuer must not deny benefits for services performed by a registered or advanced registered nurse under Chapter RCW if the service performed was within the lawful scope of their license, and the contract would have provided benefits if the service had been performed by a licensee under Chapter RCW. Restorative Services Required Services WAC See, also, WAC 284-43-5702(6). Plan must cover restorative care in a manner substantially equal to the base benchmark plan, including at least the following services: WAC Benchmark plan Plan must cover composite and amalgam restorations (fillings) on the same tooth every two years. Allowable limitations Benchmark plan Plan may limit restorations to the following: Maximum of five surfaces per tooth for permanent posterior teeth, except for upper molars; Maximum of six surfaces per tooth for teeth one, two, three, 14, 15 and 16; Maximum of six surfaces per for permanent anterior teeth; and
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