A new state law, E2SHB 1357, reduces the timeframes for state regulated carriers to respond to prior authorization requests for medical services and prescription drugs with the changes effective January 1, 2024. The new timeframes are in the table below. Note, “electronic” includes existing electronic methods for prior authorization requests and is not limited to prior authorization through an application programming interface (API). Also, the new requirements apply to state regulated insurance (individual and small group) and may not apply to enrollees of self-funded groups.
| Type of Authorization | Nonelectronic | Electronic |
| Standard | 5 days from submission | 3 calendar days, excluding holidays |
| Expedited | 2 calendar days | 1 calendar day |
If a hospital or provider believes a carrier is not complying with the new prior authorization response timelines for state-regulated programs they may contact the Office of the Insurance Commissioner (OIC) here.
E2SHB 1357 ensures that federal requirements for carriers to provide an API process for prior authorization will also apply for state-regulated insurance. At this point, the API requirements will apply to state regulated insurance for medical services effective January 1, 2026, and January 1, 2027 for prescription drugs. API requirements for federal programs, including Medicare and Medicare Advantage, will be effective January 1, 2027. More information and a link to OIC’s implementation update is available here. (Andrew Busz, andrewb@wsha.org)
