Licensed same or related health field as the provider being reviewed or of a Provider specialty whose practice entails the same or similar covered service. No Required RCW 48.43.016(5) Carrier may not require a provider to provide a discount from usual Discounts and customary rates for services not covered under a plan to which the provider is a party. Required WAC Plan must cover removable prosthodontics and prosthodontic-related Prosthodontic See, procedures in a manner substantially equal to the base benchmark plan Services Services also, WAC including, at a minimum: (Removable) WAC One resin based partial denture; replacement covered if provided at least three years after the seat date; WAC One complete denture and lower and one replacement denture per lifetime after at least 5 years from the seat date; WAC Rebasing and relining of complete or partial dentures once in a 3 year period, if performed at least 6 months from the seat date. Benchmark plan Occlusal guards for enrollees age 12 and older. Benchmark plan Adjustment and repair of dentures and bridges; Benefits need not be provided for adjustments or repairs done within one year of insertion. Provider Participating 284-170-130(23) “Participating provider” must be defined (whether or not this Require- Provider definition is set forth in the policy) consistent with the statutory and ments Definition regulatory definitions: "’Participating provider’ means a facility or provider who, under a contract with the health carrier or with the carrier’s contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other
Licensed Provider same or related health field as the provider being reviewed or of a specialty whose practice entails the same or similar covered service. No Required Discounts RCW 48.43.016(5) Carrier may not require a provider to provide a discount from usual and customary rates for services not covered under a plan to which the provider is a party. Services (Removable) Required Prosthodontic Services WAC See, also, WAC Plan must cover removable prosthodontics and prosthodontic-related procedures in a manner substantially equal to the base benchmark plan including, at a minimum: WAC One resin based partial denture; replacement covered if provided at least three years after the seat date; WAC One complete denture and lower and one replacement denture per lifetime after at least 5 years from the seat date; WAC Rebasing and relining of complete or partial dentures once in a 3 year period, if performed at least 6 months from the seat date. Benchmark plan Occlusal guards for enrollees age 12 and older. Benchmark plan Adjustment and repair of dentures and bridges; Benefits need not be provided for adjustments or repairs done within one year of insertion. Provider Require- ments Participating Provider Definition 284-170-130(23) “Participating provider” must be defined (whether or not this definition is set forth in the policy) consistent with the statutory and regulatory definitions: "’Participating provider’ means a facility or provider who, under a contract with the health carrier or with the carrier’s contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other
cl-forms-19-disability-sg-stand-alone-dental-w-pediatric-ehbs.docx