Wash. Admin. Code § 284-170-260 - Provider directories
(1) For
each carrier that uses a provider network, the carrier must make information
about that network available to the general public, prospective enrollees and
enrollees, in the form of an easily accessible and searchable online provider
directory. Easily accessible for the purposes of this section means:
(a) The general public is able to view all of
the current providers for each plan in the provider directory on the carrier's
public website through a clearly identifiable link or tab and without creating
or accessing an account or entering a policy number; and
(b) If a carrier maintains multiple provider
networks, the carrier must post the current provider directory for each plan so
the general public is able to easily discern which providers participate in
which plans and which provider networks.
(2) Carriers must make a printed copy of the
current provider directory available to an enrollee upon request as required
under RCW 48.43.510(1)(g). The printed directory must contain the carrier's
telephone number, including a TTY/TTD number, and any other contact information
to enable the enrollee to obtain information about providers in the health plan
network.
(3) Printed and online
provider directories must be made available to the general public, prospective
enrollees and enrollees in a manner that accommodates individuals with
limited-English proficiency or disabilities.
(4) Printed and online provider directories
must be updated for accuracy at least monthly. To ensure accuracy:
(a) Each provider directory must include
clear instructions about how a consumer or an enrollee can report inaccurate
information in the provider directory to the carrier.
(b) Carriers must have an easily available
method for providers to report changes to their provider directory information,
in addition to any reports associated with initial or renewed credentialing
used by the carrier.
(c) Carriers
must investigate reported inaccuracies from providers and consumers, and if
verified, correct inaccuracies as part of the carrier's monthly
updates.
(d) Carriers must
establish processes and procedures to confirm the accuracy of provider
directory information, including processes and procedures to ensure that
changes are made when inaccuracies are verified. Carriers must provide the
processes and procedures and any associated records, including the provider
directories, to the commissioner upon request for review.
(5) Printed and online provider directories
must include the following information for each provider:
(a) The provider's location and telephone
number;
(b) The specialty area or
areas for which the provider is licensed to practice and included in the
network;
(c) Any in-network
institutional affiliation of the provider, such as hospitals where the provider
has admitting privileges or provider groups with which a provider is a
member;
(d) Whether the provider
may be accessed without referral;
(e) Any languages, other than English, spoken
by the provider; and
(f) If a
provider offers mental health or substance use disorder treatment services,
identify in the directory that the provider is contracted to deliver mental
health or substance use disorder treatment services.
(6) A carrier must include in its printed and
online provider directories a notation of any primary care, chiropractor,
women's health care provider, mental health provider, substance use disorder
provider, or pediatric provider whose practice is closed to new
patients.
(7) Printed and online
provider directories must include information about any available telemedicine
services, including any audio-only telemedicine services that are available,
and specifically describe the services and how to access those
services.
(8) Printed and online
provider directories must include information about any available interpreter
services, communication and language assistance services, and accessibility of
the physical facility, and the mechanism by which an enrollee may access such
services.
(9) Printed and online
provider directories must include information about the network status of
emergency providers as required by WAC 284-170-370.
(10) In both printed and online provider
directories, the carrier must indicate that, if an enrollee is unable to locate
a gender affirming treatment provider, the carrier must identify a gender
affirming treatment provider.
Notes
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