June 14, 2016

On June 1, 2016, the Office of the Insurance Commissioner adopted amendments to Wash. Admin. Code §284-43-2000 to streamline the prior authorization process for health insurance issuers. This amendment provides additional time for an issuer to make prior authorization decisions if the request includes insufficient information. For example, for urgent care requests, the issuer must approve or deny the request within 48 hours if there is sufficient information to make the determination. If the information is insufficient, the issuer must request additional information from the provider and then approve or deny the request within 48 hours of receiving the additional information. The deadlines are also changed for non-urgent requests to allow for additional time. The law is effective Jan. 1, 2017.

Although the law affects the way that issuers will adjudicate claims, employers should be aware of these changes in prior authorization decision processes.

Wash. Admin. Code §284-43-2000 »