Coverage of RCW 48.44.225 Issuer may not refuse to pay for covered services solely because Podiatry RCW 48.44.300 the services were provided by a Podiatrist or Podiatric Surgeon. Category of Provider (Cont’d) Experimental WAC If the contract includes exclusion, reduction or limitation for or services that are experimental or investigational, contract must include a definition of Experimental and Investigational Investigational Treatment services. WAC The definition must include an identification of the 284-44-043 (2) authority or authorities which will make a determination of which services will be considered to be experimental or investigational. WAC If the HCSC or an affiliated entity is the authority making the 284-44-043 (2) determination, it must state the criteria it will utilize to make the determination. This requirement may be satisfied by
Category of Provider (Cont’d) Coverage of Podiatry RCW 48.44.225 RCW 48.44.300 Issuer may not refuse to pay for covered services solely because the services were provided by a Podiatrist or Podiatric Surgeon. Experimental or Investigational Treatment WAC If the contract includes exclusion, reduction or limitation for services that are experimental or investigational, contract must include a definition of Experimental and Investigational services. WAC 284-44-043 (2) The definition must include an identification of the authority or authorities which will make a determination of which services will be considered to be experimental or investigational. WAC 284-44-043 (2) If the HCSC or an affiliated entity is the authority making the determination, it must state the criteria it will utilize to make the determination. This requirement may be satisfied by
checklist-forms-2018-hcsc-individual-analyst-checklist.docx