Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43B - Balance billing › Section 284-43B-035 - Arbitration initiation and selection of arbitrator

Current through Register Vol. 24-14, July 15, 2024
(1)
(a) To initiate arbitration, the carrier,
			 provider, or facility must provide written notification to the commissioner and
			 the noninitiating party no later than 10 calendar days following completion of
			 the period of good faith negotiation under WAC
			 284-43B-030(3)
			 using the arbitration initiation request form found in Appendix A of this rule.
			 A request must be submitted electronically through the website of the office of
			 the insurance commissioner. When multiple claims are addressed in a single
			 arbitration proceeding, subsection (3) of this section governs calculation of
			 the 10 calendar days. Each arbitration initiation request must be submitted to
			 the commissioner individually and constitutes a distinct arbitration proceeding
			 unless consolidation of requests is authorized by a court under chapter 7.04A
			 RCW. The commissioner will assign a unique number or designation to each
			 arbitration initiation request. The parties must include that designation in
			 all communication related to that request. Any information submitted to the
			 commissioner with the arbitration initiation request must be included in the
			 notice to the nonini-tiating party under
			 RCW
			  48.49.040. A provider or facility initiating
			 arbitration must send the arbitration initiation request form to the email
			 address appearing on the website established by the designated lead
			 organization for administration simplification in Washington state under (c) of
			 this subsection. Any patient information submitted to the commissioner with an
			 arbitration initiation request form must be de-identified to ensure that
			 protected health information is not disclosed.
(b) The written notification to the
			 commissioner must be made electronically and provide dates related to each of
			 the time period limitations described in WAC
			 284-43B-030(1) through
			 (3)  and subsection (1)(a) of this section.
			 The commissioner's review of the arbitration initiation request form is limited
			 to the information necessary to determine that the request has been timely
			 submitted and is complete. The commissioner's review does not include a review
			 of whether particular claims included in the request are subject to chapter
			 48.49 RCW or whether claims are appropriately bundled under subsection (3) of
			 this section. A party seeking to challenge whether a claim is subject to
			 chapter 48.49 RCW or whether claims are appropriately bundled may raise those
			 issues during arbitration.
(c) Each
			 carrier must provide the designated lead organization for administrative
			 simplification in Washington state with the email address and telephone number
			 of the carrier's designated contact for receipt of notices to initiate
			 arbitration. The email address and phone number provided must be specific to
			 the carrier staff responsible for receipt of notices or other actions related
			 to arbitration proceedings. The initial submission of information to the
			 designated lead organization must be made on or before November 10, 2020. The
			 carrier must keep its contact information accurate and current by submitting
			 updated contact information to the designated lead organization as directed by
			 that organization.