48.43.055 - Procedures for review and adjudication of health care provider complaints -- Requirements.

Procedures for review and adjudication of health care provider complaints — Requirements.

Each health carrier as defined under RCW 48.43.005 shall file with the commissioner its procedures for review and adjudication of complaints initiated by health care providers. Procedures filed under this section shall provide a fair review for consideration of complaints. Every health carrier shall provide reasonable means allowing any health care provider aggrieved by actions of the health carrier to be heard after submitting a written request for review. If the health carrier fails to grant or reject a request within thirty days after it is made, the complaining health care provider may proceed as if the complaint had been rejected. A complaint that has been rejected by the health carrier may be submitted to nonbinding mediation. Mediation shall be conducted under chapter 7.07 RCW, or any other rules of mediation agreed to by the parties. This section is solely for resolution of provider complaints. Complaints by, or on behalf of, a covered person are subject to the grievance processes in RCW 48.43.530.

[2005 c 172 § 19; 2002 c 300 § 6; 1995 c 265 § 20.]

Notes: Short title -- Captions not law -- Severability -- Effective date -- 2005 c 172: See RCW 7.07.900 through 7.07.902 and7.07.904 .

Captions not law -- Effective dates -- Savings -- Severability -- 1995 c 265: See notes following RCW 70.47.015.