OIC Releases Carrier Reports on Prior Authorization

January 6, 2021

The Washington State Office of the Insurance Commissioner (OIC) recently posted a copy of its report to the legislature and data appendix of prior authorization metrics by major health insurance carriers. The reports are a result of Senate Bill 6404 passed during the 2020 legislative session – WSHA advocated strongly for passage of the bill. WSHA, along with the Washington State Medical Association, worked with the OIC, insurance carriers, and legislators to craft a reporting process to provide information that may be used to identify areas of focus for administrative simplification and standardization efforts. The report includes information such prior authorization approval rates for high volume services in various categories (such as inpatient procedures, outpatient procedures, behavioral and substance abuse treatment) asl well as the length of time for the carrier to respond to the authorization requests.

While SB 6404 calls for a single aggregated report, OIC indicated aggregation of the data was not possible for the initial reporting period due to variation in how carriers classified services.  Instead, the data is presented in separate deidentified tabs for each carrier.  OIC plans to convene a workgroup to determine common coding standards in advance of the next reporting period. WSHA believes the posted information is valuable as it helps demonstrate the degree of variation in requirements between carriers and the number of services requiring prior authorization that are nearly always approved. We encourage hospitals and providers to review the information in the data appendix pertaining to the services they provide.  (Andrew Busz, AndrewB@wsha.org)


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