The Office of the Insurance Commissioner’s (OIC) released the final rule and concise explanatory statement (CES) implementing House Bill 1065, the Balance Billing Protection Act (BBPA). WSHA is preparing an updated version of its earlier bulletin to incorporate links to materials for the new information. The updated bulletin will be sent in the first week of January.
The final rule includes several changes specifically requested by WSHA, including:
- The definition of in-network provider under single case agreements is clarified to apply only to the parties to the agreement;
- Carriers must use a uniform X12 271 standard transaction to enable providers to lookup the applicability of patient’s coverage to the BBPA. Technical specifications for the transaction standard is here ;
- The concise explanatory statement provides details regarding how OIC will interpret enforcement provisions of the BBPA;
- The final rule clarifies that the requirement that facilities and providers post listing of provider networks applies to existing contracts as of January 1, 2020, as well as contracts executed after that date.
Links to more information including arbitration, related data reports, and the self-funded plan election process is available here.
OIC has also provided links to recordings of the recent webinars it provided for providers and health insurers. The webinars include question and answer sessions. While these were not WSHA webcasts, WSHA believes they provide a helpful overview of OIC’s interpretation and implementation of the BBPA. WSHA recommends hospital and clinic staff responsible for compliance with BBPA provisions, including appointment scheduling, insurance verification, billing, health plan contracting, and dispute resolution view the webinars. (Andrew Busz, andrewb@wsha.org).
