Current through Register Vol. 21-24, December 15, 2021
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1. This form
and any attachments submitted will become public records and are subject to
public disclosure laws. Do not provide sensitive or confidential information
that is not necessary for the OIC to assign the claim to arbitration (you will
have the opportunity to submit relevant information during the arbitration).
OIC may dispose of any documents filed that are not necessary to process a
claim for arbitration. Personal health information (PHI) disclosed to OIC is
not subject to public disclosure under
RCW
48.02.068.
2. Only claim payments made in connection
with health insurance plans regulated by OIC and self-funded group health plans
that have elected to participate in balance billing protections can use the
arbitration process. Examples of health insurance plans that are not included
are:
* Medicare and Medicaid
* Federal employee benefit plans
Please check the list of self-funded group health plans at
https://www.insurance.wa.gov/self-funded-group-health-plans
to determine whether a self-funded group health plan has elected to participate
in balance billing protections for their members.
3. An out-of-network provider or facility
providing emergency, surgical or ancillary services at an in-network facility
may submit this request if it is believed that the payment made for the covered
services was not a commercially reasonable amount. A carrier or self-funded
group health plan that has elected to participate in balance billing
protections for its members may also submit a request for
arbitration.
4. Upon OIC review and
acceptance of a request for arbitration, both the initiating and non-initiating
parties will be provided with a list of approved arbitrators and arbitration
entities by OIC. If the parties cannot agree on an arbitrator or arbitration
entity, OIC will choose one and notify the parties, using the process outlined
in WAC 284-436-035(5). Within 10 business days of the initiating party
notifying the commissioner and the non-initiating party of intent to initiate
arbitration, both parties must agree to and execute a nondisclosure
agreement.
5. Once the arbitrator
has been chosen, OIC will send the arbitrator/arbitration entity a copy of the
Arbitration Initiation Request Form and both parties will have 30 days to make
written submissions to the arbitrator. A party that fails to make timely
written submissions without good cause shown will be considered to be in
default and will be ordered to pay the final offer amount submitted by the
party not in default. They arbitrator also can require the party in default to
pay expenses incurred to date in the course of arbitration, including the
arbitrator's expenses and fees and the reasonable attorneys' fees of the party
not in default.
6. No later than 30
calendar days after the receipt of the parties' written submissions, the
arbitrator will: Issue a written decision requiring payment of the final offer
amount of either the initiating party or the non-initiating party, notify the
parties of its decision, and provide the decision as well as the information
described in
RCW 48.49.050
regarding the decision to OIC.