PREPROPOSAL STATEMENT OF INQUIRY
Subject of Possible Rule Making: The commissioner will consider new rules to improve efficiency and reduce costs through the use of uniform claim forms and other common administrative procedures for health insurers. The commissioner will oversee a process facilitated by the Community Health Information Technology Alliance (CHITA) to develop and recommend the use of uniform processes for the administrative functions of health carriers. These rules may include a direction that carriers use forms and procedures to reduce duplication among carriers such as use of CHITA's "standard referral form." Among the topics for consideration are uniform billing and claims forms, referral forms, authorization forms, and audit standards. To the extent that CHITA does not include such topics in its work, the commissioner will form other similar working groups comprised of carriers, health care professionals and facilities, and other health care payer groups who will develop recommendations.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.30.010, 48.44.020, 48.44.050, 48.44.070, 48.46.060, 48.46.200, and 48.46.243, chapter 48.46 RCW.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Recent hearings held by the commissioner revealed a growing need to establish uniform standards for basic administrative procedures among health insurers and other payers. Health care professionals are spending more and more each year to comply with the complex and multiple administrative demands of various health care payers including insurers and HMOs. Uniform standards would reduce frustration, cost, and complexity without substantially affecting the ability of payers to perform their administrative duties.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: State agencies including the Health Care Authority and the Department of Social and Health Services are payers for health care services and may require the use of particular administrative forms and procedures for payment of health care. The commissioner will work directly with these other agencies and through CHITA to assure maximum uniformity among health care payers.
Process for Developing New Rule: Negotiated rule making; and the commissioner will form working groups to the extent that the Community Health Information Technology Alliance (a nonprofit research and policy organization whose members include insurers and health care providers) is unable to facilitate a process for the development of agreed upon uniform administrative processes and standards.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting John S. Conniff, phone (360) 664-3786, Internet JohnC@oic.wa.gov; or Kacy Brandeberry, P.O. Box 40256, Olympia, WA 98504-0256, phone (360) 407-0729, fax (360) 407-0186, Internet KacyB@oic.wa.gov.
October 11, 1999
Robert A. Harkins
Chief Deputy Commissioner