OIC Releases Final Rule on Balance Billing Protection Act

November 4, 2020

November 2, the Office of the Insurance Commissioner (OIC) finalized additional rulemaking and a concise explanatory statement related to the Balance Billing Protection Act (BBPA), which prohibits balance billing for certain out of network services and provides an arbitration process between carriers and providers for payment disputes. While the basic structure of the BBPA has been in effect since January 1, 2020, the additional rules provide greater clarity regarding notification responsibilities and the arbitration process. WSHA was actively involved in the rulemaking process and obtained clarity that bundling of claims for arbitration can be done at the group level rather than the individual practitioner level as long as the group is under the same tax ID number. Also, at WSHA’s request, OIC increased the period for hospitals to provide patients with the BBPA notice of consumer rights following emergency services. WSHA will be preparing and providing a bulletin outlining the specifics of the new rulemaking. (Andrew Busz, AndrewB@wsha.org)


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