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PDFWAC 284-43B-040

Determining whether an enrollee's health plan is subject to the requirements of the act.

(1) To implement RCW 48.49.030 carriers must make information regarding whether an enrollee's health plan is subject to the requirements of chapter 48.49 RCW available to providers and facilities by:
(a) Using the most current version of the Health Insurance Portability and Accountability Act (HIPAA) mandated X12 Health Care Eligibility Benefit Response (271) transaction information through use of a standard message that is placed in a standard location within the 271 transaction; and
(b) Beginning April 1, 2021, using the most current version of the Health Insurance Portability and Accountability Act (HIPAA) mandated X12 Health Care Claim Payment and Remittance Advice (835) transaction through compliant use of the X12 industry standard Remark Code N830 to indicate that the claim was processed in accordance with this state's balance billing rules.
(2) The designated lead organization for administrative simplification in Washington state:
(a) After consultation with carriers, providers and facilities through a new or an existing workgroup or committee, must post the language of the standard message and the location within the 271 transaction in which the message is to be placed on its website on or before November 1, 2019;
(b) Must post on its website on or before December 1, 2020, instructions on compliant use of the X12 industry standard Remark Code N830 in the X12 Health Care Claim Payment and Remittance Advice (835) transaction; and
(c) Must post on its website on or before December 1, 2020, the information reported by carriers under WAC 284-43B-035(1).
(3) A link to the information referenced in subsection (2) of this section also must be posted on the website of the office of the insurance commissioner.
[Statutory Authority: RCW 48.49.060 and 48.49.110. WSR 20-22-076, § 284-43B-040, filed 11/2/20, effective 12/3/20. Statutory Authority: RCW 48.02.060, 48.49.060, and 48.49.110. WSR 19-23-085, § 284-43B-040, filed 11/19/19, effective 12/20/19.]
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