Appeals Internal Appeals RCW The issuer must assist the enrollee with the appeal process. under Grand- 48.43.530(5)(b) Procedures fathered Health WAC (Cont’d) Plan (Cont’d) WAC RCW The issuer must cooperate with any representative 48.43.530(5)(d) authorized in writing by the enrollee. WAC RCW The issuer must consider all information submitted by the 48.43.530(5)(e) enrollee or representative. WAC WAC RCW The issuer must investigate and resolve all appeals / 48.43.530(5)(f) requests for review of adverse benefit determination. WAC RCW The review of a decision to deny, modify, reduce, or 48.43.530(4)(a) terminate payment, coverage, authorization, or provision of health care services or benefits, including admission to, or continued stay in, a health care facility, is processed as an appeal. Appeals Internal Appeals WAC The issuer must: under Procedures respond to oral and written appeals in a timely and Health (Cont’d) thorough manner; Plans (Cont’d) notify the enrollee that an appeal has been received.
Appeals Procedures (Cont’d) Internal Appeals under Health Plan (Cont’d) RCW 48.43.530(5)(b) WAC WAC The issuer must assist the enrollee with the appeal process. RCW 48.43.530(5)(d) WAC The issuer must cooperate with any representative authorized in writing by the enrollee. RCW 48.43.530(5)(e) WAC WAC The issuer must consider all information submitted by the enrollee or representative. RCW 48.43.530(5)(f) WAC The issuer must investigate and resolve all appeals / requests for review of adverse benefit determination. RCW 48.43.530(4)(a) The review of a decision to deny, modify, reduce, or terminate payment, coverage, authorization, or provision of health care services or benefits, including admission to, or continued stay in, a health care facility, is processed as an appeal. Appeals Procedures (Cont’d) Internal Appeals under Health Plans (Cont’d) WAC The issuer must: respond to oral and written appeals in a timely and thorough manner; notify the enrollee that an appeal has been received. Grand- fathered
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