Washington § 48.43.520 - Requirement to maintain a documented utilization review program description and written utilization review criteria — Rules. (Effective until January 1, 2027.)

Full text of Washington Revised Code of Washington § 48.43.520 — Requirement to maintain a documented utilization review program description and written utilization review criteria — Rules. (Effective until January 1, 2027.), with citation guidance and answers to common questions.

§ 48.43.520. Requirement to maintain a documented utilization review program description and written utilization review criteria — Rules. (Effective until January 1, 2027.)

(1) Carriers that offer a health plan shall maintain a documented utilization review program description and written utilization review criteria based on reasonable medical evidence. The program must include a method for reviewing and updating criteria. Carriers shall make clinical protocols, medical management standards, and other review criteria available upon request to participating providers.
(2) The commissioner shall adopt, in rule, standards for this section after considering relevant standards adopted by national managed care accreditation organizations and state agencies that purchase managed health care services.
(3) A carrier shall not be required to use medical evidence or standards in its utilization review of religious nonmedical treatment or religious nonmedical nursing care.
[ 2000 c 5 s 8.]

Notes

Application—Short title—Captions not law—Construction—Severability—Application to contracts—Effective dates—2000 c 5: See notes following RCW 48.43.500.
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RCW 48.43.520

Source: official Washington text · Last verified 2026-08-27

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Frequently Asked Questions About Washington § 48.43.520

What does Revised Code of Washington § 48.43.520 cover?

Section 48.43.520 ("Requirement to maintain a documented utilization review program description and written utilization review criteria — Rules. (Effective until January 1, 2027.)") is part of the Revised Code of Washington, the codified statutory law of Washington. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.

How do I cite Washington § 48.43.520?

A common citation format is "Revised Code of Washington § 48.43.520" (Washington). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.

Is this the official text of Washington law?

No. This page is for research and education and may not include the most recent amendments. For official current law, check the Washington official source linked on this page or consult a licensed Washington attorney.

How does Washington § 48.43.520 apply to my situation?

Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Washington can advise on how this section applies to you. Contact your state or local bar association for a referral.

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Not legal advice. Verify against the official source and consult a licensed attorney in Washington.