296-20-01030  <<  296-20-01040 >>   296-20-01050

WAC 296-20-01040

Health care provider network continuing requirements.

To continue to provide care for workers and be paid for those services, a provider must:
(1) Provide services without unlawful discrimination;
(2) Provide services and bill according to federal and state laws and rules, department rules, policies, and billing instructions;
(3) Maintain material compliance with minimum provider network standards, department credentialing and recredentialing standards, and department's evidence-based coverage decisions and treatment guidelines, policies; and must follow other national treatment guidelines appropriate for their patient;
(4) Inform the department or an applicable delegated credentialing entity of any material changes to the provider's application or agreement within fourteen calendar days including, but not limited to, changes in:
(a) Ownership or business name;
(b) Address or telephone number;
(c) Professionals practicing under the billing provider number;
(d) Any informal or formal disciplinary order, decision, disciplinary action or other action(s), including any criminal action, in any state;
(e) Provider clinical privileges;
(f) Malpractice claims or professional liability coverage;
(5) Retain a current professional state license, registration, certification and/or applicable business license for the service being provided, and update the department of all changes;
(6) Comply with department recredentialing process; and
(7) Comply with the instructions contained in a department action, including documentation of compliance and participation in mentoring, monitoring, or restrictions.
[Statutory Authority: RCW 51.36.010, 51.04.020, and 51.04.030. WSR 12-02-058, ยง 296-20-01040, filed 1/3/12, effective 2/3/12.]
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