(d) requirements; 48.43.510(1) summary explanation of the carrier's review of adverse benefit (e) determinations and grievance processes; 48.43.510(1) statement regarding the availability of a point-of-service option, if (f) any, and how the option operates; and 48.43.510(1) convenient means of obtaining lists of participating primary care and (g); specialty care providers, including disclosure of network arrangements that restrict access to providers within any plan network. RCW Contract must contain the following written information or notify the 48.43.510(2)(a) enrollee that he is entitled to it upon request: Any documents, instruments, or information referred to in the medical coverage agreement; RCW A full description of the procedures to be followed by an enrollee for 48.43.510(2)(b) consulting a provider than the primary care provider and whether any entity must authorize the referral; RCW Procedures, if any, that an enrollee must first follow for obtaining prior 48.43.510(2)(c) authorization for health care services; RCW A written description of any reimbursement or payment arrangements 48.43.510(2)(d) between the issuer and providers, including capitation provisions, provisions, and health care delivery efficiency provisions; RCW Descriptions and justifications for provider compensation programs, 48.43.510(2)(e) including any incentives or penalties that are intended to encourage providers to withhold services or minimize or avoid referrals to specialists; RCW An annual accounting of all payments made by the carrier which have 48.43.510(2)(f) been counted against any payment limitations, visit limitations, or other overall limitations on a person's coverage under a plan; and
(d) requirements; 48.43.510(1) (e) summary explanation of the carrier's review of adverse benefit determinations and grievance processes; 48.43.510(1) (f) statement regarding the availability of a point-of-service option, if any, and how the option operates; and 48.43.510(1) (g); convenient means of obtaining lists of participating primary care and specialty care providers, including disclosure of network arrangements that restrict access to providers within any plan network. RCW 48.43.510(2)(a) Contract must contain the following written information or notify the enrollee that he is entitled to it upon request: Any documents, instruments, or information referred to in the medical coverage agreement; RCW 48.43.510(2)(b) A full description of the procedures to be followed by an enrollee for consulting a provider than the primary care provider and whether any entity must authorize the referral; RCW 48.43.510(2)(c) Procedures, if any, that an enrollee must first follow for obtaining prior authorization for health care services; RCW 48.43.510(2)(d) A written description of any reimbursement or payment arrangements between the issuer and providers, including capitation provisions, provisions, and health care delivery efficiency provisions; RCW 48.43.510(2)(e) Descriptions and justifications for provider compensation programs, including any incentives or penalties that are intended to encourage providers to withhold services or minimize or avoid referrals to specialists; RCW 48.43.510(2)(f) An annual accounting of all payments made by the carrier which have been counted against any payment limitations, visit limitations, or other overall limitations on a person's coverage under a plan; and
cl-forms-19-hmo-ind-analyst-checklist.docx