Washington · statute · Wash. Rev. Code ch. 48.165 · 8 active provisions
The legislature finds that:(1) The health care system in the nation and in Washington state costs nearly twice as much per capita as other industrialized nations.(2) The fragmentation and variation in administrative processes prevalent in our health care system contribute to the high cost of health care, putting it inc…
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Commissioner" means the insurance commissioner as established under chapter 48.02 RCW.(2) "Health care provider" or "provider" has the same meaning as in RCW 48.43.005 and, for the purposes of chapter 298, L…
(1) The commissioner shall designate one or more lead organizations to coordinate development of processes, guidelines, and standards to streamline health care administration and to be adopted by payors and providers of health care services operating in the state. The lead organization designated by the commissioner fo…
(1) The insurance commissioner must reauthorize the efforts with the lead organization established in RCW 48.165.030, and establish a new work group to develop recommendations for prior authorization requirements. The focus of the prior authorization efforts must include the full scope of health care services including…
By December 31, 2010, the lead organization shall:(1) Develop a uniform electronic process for collecting and transmitting the necessary provider-supplied data to support credentialing, admitting privileges, and other related processes that:(a) Reduces the administrative burden on providers;(b) Improves the quality and…
The lead organization shall:(1) Establish a uniform standard companion document and data set for electronic eligibility and coverage verification. Such a companion guide will:(a) Be based on nationally accepted ANSI X12 270/271 standards for eligibility inquiry and response and, wherever possible, be consistent with th…
(1) By December 31, 2010, the lead organization shall develop implementation guidelines and promote widespread adoption of such guidelines for:(a) The use of the national correct coding initiative code edit policy by payors and providers in the state;(b) Publishing any variations from component codes, mutually exclusiv…
(1) By December 31, 2010, the lead organization shall:(a) Develop and promote widespread adoption by payors and providers of guidelines to:(i) Ensure payors do not automatically deny claims for services when extenuating circumstances make it impossible for the provider to: (A) Obtain a preauthorization before services…