WAC The procedures for withdrawing consent and for updating the individual's electronic 284-43-520(2)(c)(v) address for receipt of electronically furnished documents or other information; Internal WAC 284-43-520 (3) The right to request and obtain a paper version of an electronically furnished document, Reviews of Adverse including whether the paper version will be provided free of charge; and Benefit Any hardware and software requirements for accessing and retaining the documents. consent, if a change in hardware or software requirements to access or retain electronic under documents creates a material risk that an enrollee will be unable to access or retain such documents, the issuer must provide information about the new requirements and the Health Plans WAC 284-43-520 opportunity to withdraw consent without consequences. The issuer must request and (Cont’d) (1)(c) and (d) receive a new consent to electronically provided documents, following such a hardware or Appeals software requirement change. Procedures With respect to documents regarding adverse benefit determinations and review of such determinations, an issuer furnishing such documents electronically is deemed to satisfy the (Cont’d) notice and disclosure requirements if: at the time a document is furnished electronically, the issuer provides notice (in electronic or nonelectronic form) that apprises the recipient of: the significance of the document when it is not otherwise reasonably evident as transmitted (e.g., attached document describes the internal review process used by “the your plan”); and The recipient’s right to request and obtain a paper version of such document; AND The issuer furnishes the appellant or their representative with a paper version of the electronically furnished documents if requested. RCW The Issuer must provide an expedited review process at any in the review process IF: 48.43.530(5)(c) The appellant is currently receiving or is prescribed treatment or benefits that would end WAC 284-43-540(1)(a) due to the adverse benefit determination; OR The determination is related to an issue related to admission, availability of care, continued WAC 284-43-540(1)(c)
Appeals Procedures (Cont’d) Internal Reviews of Adverse Benefit under Health Plans (Cont’d) WAC 284-43-520(2)(c)(v) WAC 284-43-520 (3) WAC 284-43-520 (1)(c) and (d) The procedures for withdrawing consent and for updating the individual's electronic address for receipt of electronically furnished documents or other information; The right to request and obtain a paper version of an electronically furnished document, including whether the paper version will be provided free of charge; and Any hardware and software requirements for accessing and retaining the documents. consent, if a change in hardware or software requirements to access or retain electronic documents creates a material risk that an enrollee will be unable to access or retain such documents, the issuer must provide information about the new requirements and the opportunity to withdraw consent without consequences. The issuer must request and receive a new consent to electronically provided documents, following such a hardware or software requirement change. With respect to documents regarding adverse benefit determinations and review of such determinations, an issuer furnishing such documents electronically is deemed to satisfy the notice and disclosure requirements if: at the time a document is furnished electronically, the issuer provides notice (in electronic or nonelectronic form) that apprises the recipient of: the significance of the document when it is not otherwise reasonably evident as transmitted (e.g., “the attached document describes the internal review process used by your plan”); and The recipient’s right to request and obtain a paper version of such document; AND The issuer furnishes the appellant or their representative with a paper version of the electronically furnished documents if requested. RCW 48.43.530(5)(c) WAC 284-43-540(1)(a) WAC 284-43-540(1)(c) The Issuer must provide an expedited review process at any in the review process IF: The appellant is currently receiving or is prescribed treatment or benefits that would end due to the adverse benefit determination; OR The determination is related to an issue related to admission, availability of care, continued
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