WAC 182-500-0085

Effective July 30, 2011

WAC 182-500-0085 Medical assistance definitions -- P.

"Patient transportation" means client transportation to and/or from covered healthcare services under federal and state healthcare programs.

     "Physician" means a doctor of medicine, osteopathy, or podiatry who is legally authorized to perform the functions of the profession by the state in which the services are performed.

     "Prior authorization" is the requirement that a provider must request, on behalf of a client and when required by rule, the agency's or the agency's designee's approval to render a healthcare service or write a prescription in advance of the client receiving the healthcare service or prescribed drug, device, or drug-related supply. The agency's or the agency's designee's approval is based on medical necessity. Receipt of prior authorization does not guarantee payment. Expedited prior authorization and limitation extension are types of prior authorization.

     "Prosthetic devices" means replacement, corrective, or supportive devices prescribed by a physician or other licensed practitioner of the healing arts within the scope of his or her practice as defined by state law to:

•	Artificially replace a missing portion of the body;

•	Prevent or correct physical deformity or malfunction; or
•	Support a weak or deformed portion of the body.

     "Provider" means an institution, agency, or person that is licensed, certified, accredited, or registered according to Washington state laws and rules, and:

     (1) Has signed a core provider agreement or signed a contract with the agency or the agency's designee, and is authorized to provide healthcare, goods, and/or services to medical assistance clients; or

     (2) Has authorization from a managed care organization (MCO) that contracts with the agency or the agency's designee to provide healthcare, goods, and/or services to eligible medical assistance clients enrolled in the MCO plan.

     "Public institution" see "institution" in WAC 388-500-0050.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.