OIC Requests Stakeholder Input on Electronic Verification for Surprise Billing Law

October 2, 2019

The Balance Billing Protection Act requires health plans to provide an electronic mechanism for hospitals and health care providers to determine whether a patient’s health insurance plan is subject to the requirements of the act. WSHA strongly advocated for this provision to be included in the Act. WSHA is seeking input into the draft rule governing this process – comments are due October 10, 2019.
The Office of the Insurance Commissioner (OIC) is proposing that the requirement of the act be accomplished through the HIPAA transaction known as the X12 271 Eligibility and Benefits Response Transaction. OneHealthPort, the state’s lead organization for health insurance administrative simplification, has developed draft language and requirements for the transaction. Please forward this information to staff involved in verifying enrollment and benefits. Comments should be sent directly to OneHealthPort at wec3@viaconsulting.com.
If you have specific comments or concerns regarding the proposed transaction standards, please copy Andrew Busz at andrewb@wsha.org.


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