Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › Section 296-20-01020 - Health care provider network enrollment

Current through Register Vol. 24-14, July 15, 2024
(1) The department or its delegated entity
			 will review the provider's application, supporting documents, and any other
			 information requested or accessed by the department that is relevant to
			 verifying the provider's application, clinical experience or ability to meet or
			 maintain provider network requirements.
(2) The department will notify providers of
			 incomplete applications, including when credentialing information obtained from
			 other sources materially varies from information on the provider application.
			 The provider may submit a supplement to the application with corrections or
			 supporting documents to explain discrepancies within thirty days of the date of
			 the notification from the department. Incomplete applications will be
			 considered withdrawn within forty-five days of notification.
(3) The provider must produce adequate and
			 timely information and timely attestation to support evaluation of the
			 application. The provider must produce information and respond to department
			 requests for information that will help resolve any questions regarding
			 qualifications within the time frames specified in the application or by the
			 department.
(4) The department's
			 medical director or designee is authorized to approve, deny, or further review
			 complete applications consistent with department rules and policies. Providers
			 will be notified in writing of their approval or denial, or that their
			 application is under further review within a reasonable period of
			 time.
(5) Providers who meet the
			 minimum provider network standards, have not been identified for further
			 review, and are in compliance with department rules and policies, will be
			 approved for enrollment into the network.
(6) Enrollment of a provider is effective no
			 earlier than the date of the approved provider application. The department and
			 self-insured employers will not pay for care provided to workers prior to
			 application approval, regardless of whether the application is later approved
			 or denied, except as provided in subsection (7) of this section.
(7) The department and self-insured employers
			 may pay a provider without an approved application only when:
(a) The provider is outside the scope of the
			 provider network per WAC
			 296-20-01010; or
(b) The provider is provisionally enrolled by
			 the department after it obtains:
(i)
			 Verification of a current, valid license to practice;
(ii) Verification of the past five years of
			 malpractice claims or settlements from the malpractice carrier or the results
			 of the National Practitioner Data Bank (NPDB) or Healthcare Integrity and
			 Protection Data Bank (HIPDB) query; and
(iii) A current and signed application with
			 attestation.
(c) A
			 provider may only be provisionally enrolled once and for no more than sixty
			 calendar days. Providers who have previously participated in the network are
			 not eligible for provisional enrollment.