OIC Adopts New Rule on Prior Authorization Processes and Transparency

June 7, 2017

WSHA members have been asking for steps to help with an increasingly burdensome process from private payers on prior authorization.  On June 5, after an extended stakeholder process, the Office of the Insurance Commissioner adopted a rule on prior authorization that addresses carrier transparency.  WSHA, the Washington State Medical Association, and members of both associations testified at rulemaking hearings and provided significant comments.  The new rule improves transparency for determination of prior authorization requests, provides greater accountability for benefit managers used by carriers, and requires retroactive review of services where prior authorization is not possible.

WSHA will prepare a bulletin detailing the new rule. OIC has posted a copy of the rule, and an explanatory statement, which includes stakeholder comments and OIC rationale.   The rule goes into effect July 6, 2017, though some requirements of the rule will be phased in over time. (Andrew Busz, andrewb@wsha.org).


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