Required Offer RCW Contract must contain the following written information or of Disclosure 48.43.510 notify the enrollee that he is entitled to it upon request: Items (2)(a) Any documents, instruments, or other information referred (Cont’d) to in the medical coverage agreement; A full description of the procedures to be followed by an 48.43.510 enrollee for consulting a provider other than the primary care (2)(b) provider and whether any entity must authorize the referral; 48.43.510 Procedures, if any, that an enrollee must first follow for (2)(c) obtaining prior authorization for health care services; A written description of any reimbursement or payment RCW arrangements between the issuer and providers, including 48.43.510 capitation provisions, fee-for-service provisions, and health (2)(d) care delivery efficiency provisions; Descriptions and justifications for provider compensation RCW programs, including any incentives or penalties that are 48.43.510 intended to encourage providers to withhold services or (2)(e) minimize or avoid referrals to specialists; RCW An annual accounting of all payments made by the carrier 48.43.510 which have been counted against any payment limitations, (2)(f) visit limitations, or other overall limitations on a person's coverage under a plan; and RCW Accreditation status with one or more national managed 48.43.510 care accreditation organizations, and whether the carrier Required (2)(h) tracks its health care effectiveness performance using the of Disclosure health employer data information set (HEDIS), whether it Items publicly reports its HEDIS data, and how people can access (Cont’d) its HEDIS data.
Required Offer of Disclosure Items (Cont’d) 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 other information referred to in the medical coverage agreement; 48.43.510 (2)(b) A full description of the procedures to be followed by an enrollee for consulting a provider other than the primary care provider and whether any entity must authorize the referral; 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, fee-for-service provisions, and health care delivery efficiency provisions; Required of Disclosure Items (Cont’d) 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 RCW 48.43.510 (2)(h) Accreditation status with one or more national managed care accreditation organizations, and whether the carrier tracks its health care effectiveness performance using the health employer data information set (HEDIS), whether it publicly reports its HEDIS data, and how people can access its HEDIS data.
checklist-forms-2018-disability-individual-analyst-checklist.docx