48.200.260 – Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds.
RCW 48.200.260 Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds. (1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than forty-five days after the […]
48.200.270 – Application.
RCW 48.200.270 Application. RCW 48.200.210 through 48.200.270 do not: (1) Preclude an entity from instituting an action for fraud against a pharmacy; (2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is indicated by physical review, review of claims data or statements, or other investigative methods; or (3) […]
48.200.010 – Findings—Intent.
RCW 48.200.010 Findings—Intent. (1) The legislature finds that growth in managed health care systems has shifted substantial authority over health care decisions from providers and patients to health carriers and health care benefit managers. Health care benefit managers acting as intermediaries between carriers, health care providers, and patients exercise broad discretion to affect health care […]
48.200.020 – Definitions.
RCW 48.200.020 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) “Affiliate” or “affiliated employer” means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, another specified person. (2) “Certification” has the same meaning […]
48.200.030 – Registration requirements—Application—Fees—Retention of transaction records.
RCW 48.200.030 Registration requirements—Application—Fees—Retention of transaction records. (1) To conduct business in this state, a health care benefit manager must register with the commissioner and annually renew the registration. (2) To apply for registration under this section, a health care benefit manager must: (a) Submit an application on forms and in a manner prescribed by […]
48.200.040 – Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.
RCW 48.200.040 Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality. (1) A health care benefit manager may not provide health care benefit management services to a health carrier or employee benefits programs without a written agreement describing the rights and responsibilities of the parties conforming to the provisions of this chapter and any rules […]