or subcontracting arrangement for its prior authorization program. WAC A prior authorization program must meet standards set forth by a national accreditation organization including, but not limited to, National Committee for Quality Assurance (NCQA), URAC, Joint Commission, and Accreditation Association for Ambulatory Health Care in addition to the requirements of and . A prior authorization program must have staff who are properly qualified, trained, supervised, and supported by Prior explicit written, current clinical review criteria and review Authorization procedures. Transparency RCW If the plan imposes different authorization standards and of Standards 48.43.016(1) criteria for a covered service among tiers of contracting and Criteria providers of the same licensed profession, the contract must inform enrollees which tier an individual provider or group of providers is in by posting the information on its web site in a manner accessible to both enrollees and providers. RCW Plan must post on its web site and provide upon the request of 48.43.016(3) a covered person or contracting provider any prior authorization standards, criteria, or information the carrier uses for medical necessity decisions. Prohibited RCW Plan may not require authorization for an initial evaluation Practices 48.43.016(2) and management visit and up to six consecutive treatment visits with a contracted provider in a new episode of care of chiropractic, physical therapy, occupational therapy, East Asian
or subcontracting arrangement for its prior authorization program. Prior Authorization WAC A prior authorization program must meet standards set forth by a national accreditation organization including, but not limited to, National Committee for Quality Assurance (NCQA), URAC, Joint Commission, and Accreditation Association for Ambulatory Health Care in addition to the requirements of and . A prior authorization program must have staff who are properly qualified, trained, supervised, and supported by explicit written, current clinical review criteria and review procedures. Transparency of Standards and Criteria RCW 48.43.016(1) If the plan imposes different authorization standards and criteria for a covered service among tiers of contracting providers of the same licensed profession, the contract must inform enrollees which tier an individual provider or group of providers is in by posting the information on its web site in a manner accessible to both enrollees and providers. RCW 48.43.016(3) Plan must post on its web site and provide upon the request of a covered person or contracting provider any prior authorization standards, criteria, or information the carrier uses for medical necessity decisions. Prohibited Practices RCW 48.43.016(2) Plan may not require authorization for an initial evaluation and management visit and up to six consecutive treatment visits with a contracted provider in a new episode of care of chiropractic, physical therapy, occupational therapy, East Asian
cl-forms-19-hcsc-ind-analyst-checklist.docx