The definitions in this section apply throughout this chapter unless the context clearly
(1) “Commissioner” means the insurance commissioner as established under chapter 48.02 RCW.
(2) “Health care provider” or “provider” has the same meaning as in RCW 48.43.005 and, for the purposes of chapter 298, Laws of 2009, shall include facilities licensed
under chapter 70.41 RCW.
(3) “Lead organization” means a private sector organization or organizations designated by the commissioner
to lead development of processes, guidelines, and standards to streamline health care
administration and to be adopted by payors and providers of health care services operating
in the state.
(4) “Medical management” means administrative activities established by the payor to manage the utilization
of services through preservice or postservice reviews. “Medical management” includes, but is not limited to:
(a) Prior authorization or preauthorization of services;
(b) Precertification of services;
(c) Postservice review;
(d) Medical necessity review; and
(e) Benefits advisory.
(5) “Payor” means public purchasers, as defined in this section, carriers licensed under chapters
48.20, 48.21, 48.44, 48.46, and 48.62 RCW, and the Washington state health insurance pool established in chapter 48.41 RCW.
(6) “Public purchaser” means the department of social and health services, the department of labor and
industries, and the health care authority.
(7) “Secretary” means the secretary of the department of health.
(8) “Third-party payor” has the same meaning as in RCW 70.02.010.
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
Was this helpful?
Response sent, thank you
Welcome to FindLaw's Cases & Codes
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw's Learn About the Law.