WAC 296-15-330   Authorization of medical care.  What are the requirements for authorization of medical care? Every self-insurer must:

     (1) Authorize treatment and pay bills in accordance with Title 51 RCW and the medical aid rules and fee schedules of the state of Washington.

     (2) Provide a written explanation of benefits (EOB) to the provider, with a copy to the worker if requested, for each bill adjustment. A written explanation is not required if the adjustment was made solely to conform to the maximum allowable fees as set by the department.

     (3) Establish procedures to ensure prompt responses to inquiries regarding authorization decisions and bill adjustments.



[Statutory Authority: RCW 51.04.020, 51.14.020, 51.32.190, 51.14.090, and 51.14.095. 06-06-066, § 296-15-330, filed 2/28/06, effective 4/1/06.]