48.43.091 - Health carrier coverage of outpatient mental health services -- Requirements. - Washington Statutes

Health carrier coverage of outpatient mental health services — Requirements.

Every health carrier that provides coverage for any outpatient mental health service shall comply with the following requirements:

     (1) In performing a utilization review of mental health services for a specific enrollee, the utilization review is limited to accessing only the specific health care information contained in the enrollee's record.

     (2) In performing an audit of a provider that has furnished mental health services to a carrier's enrollees, the audit is limited to accessing only the records of enrollees covered by the specific health carrier for which the audit is being performed, except as otherwise permitted by RCW 70.02.050 and 71.05.630.

[1999 c 87 § 1.]