WSHA contacted the Washington State office of the Insurance Commissioner (OIC) about their strategy for monitoring and enforcement of requirements for transparency and accountability of health plan prior authorizations (WAC 284-43-2050 and WAC 284-43-2060). WSHA provided significant input in the drafting of the WAC rules a few years ago. The rules require health plan transparency of prior authorization criteria and require electronic prior authorization to be available as of November 1, 2019. The OIC encourages hospitals and providers that experience a health insurer not in compliance with the electronic prior authorization requirements to contact the OIC’s hotline at 1-800-562-6900.
The OIC also recently advised WSHA that they will be conducting random audits of health insurers related to the prior authorization requirements to ensure compliance. If you are experiencing issues with carrier compliance and OIC enforcement, please also contact Andrew Busz at email@example.com so we are aware and can determine if additional regulatory or legislative response is needed.