WASHINGTON STATUTES AND CODES

48.165.010 - Definitions.

Definitions.

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

     (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.