RCW The issuer must cooperate with any representative authorized in 48.43.530(5)(d) writing by the enrollee. WAC RCW The issuer must consider all information submitted by the enrollee 48.43.530(5)(e) or representative. WAC WAC Appeals Internal Appeals RCW The issuer must investigate and resolve all appeals / requests for under 48.43.530(5)(f) Procedures review of adverse benefit determination. Health WAC (Cont’d) Plans (Cont’d) RCW The review of a decision to deny, modify, reduce, or terminate 48.43.530(4)(a) 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. 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. WAC An enrollee or the enrollee's representative, including the treating provider (regardless of whether the provider is contracted with the issuer) acting on behalf of the enrollee may appeal an adverse determination in writing. The issuer must reconsider the adverse determination and notify the enrollee of its decision within fourteen days of receipt of the appeal.
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. Appeals Procedures (Cont’d) Internal Appeals under Health Plans (Cont’d) 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. 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. WAC An enrollee or the enrollee's representative, including the treating provider (regardless of whether the provider is contracted with the issuer) acting on behalf of the enrollee may appeal an adverse determination in writing. The issuer must reconsider the adverse determination and notify the enrollee of its decision within fourteen days of receipt of the appeal.
cl-forms-19-disability-ind-analyst-checklist.docx