WSR 19-12-087
[Filed June 4, 2019, 11:07 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-09-089.
Title of Rule and Other Identifying Information: WAC 296-15-232 Self-insurance medical bill electronic data interchange.
Hearing Location(s): On July 15, 2019, at 10:00 a.m., at the Department of Labor and Industries (L&I), Auditorium, 7273 Linderson Way S.W., Tumwater, WA 98501. For directions to L&I
Date of Intended Adoption: August 20, 2019.
Submit Written Comments to: K. C. Wilkerson, P.O. Box 44890, Olympia, WA 98504-4890, email, fax 360-902-6977, by July 17, 2019.
Assistance for Persons with Disabilities: Contact K. C. Wilkerson, phone 360-902-6851, fax 360-902-6977, email, by July 1, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing to adopt one new rule. This rule making involves significant legislative changes. The goals of the new rule are to create standardized medical bill reporting expectations for self-insured employers, to support the collection of quality data, and to create a reporting exemption for qualifying employers.
The key proposals are:
Self-insured employers are required to report medical bills through the medical bill electronic data interchange (EDI).
Self-insured employers are required to report bills accurately and timely.
Under limited circumstances, self-insured employers can be provided an exception, which means that they are exempt from reporting.
Standardized reporting will build data integrity, improve industry benchmarking, and inform and support policy conversations and decisions.
Reasons Supporting Proposal: In 2016 L&I and the self-insured employer community partnered to develop the self-insurance risk analysis system (SIRAS). Part of SIRAS includes the development of EDI to collect workers' compensation claims' medical bill data. Funding for the development of EDI came from the self-insured community, and their expectation has always been that participation would be required once the system was fully implemented.
The Washington self-insurers association (WSIA) has been consistently consulted in EDI's implementation, and they have reviewed and contributed to the EDI rule. To date, approximately ninety-eight percent of the self-insured employer community has already registered to report medical bill data, and approximately eighty-four percent of them have already reported medical bill data. This rule making will document standards and requirements for the reporting that is already largely taking place.
Statutory Authority for Adoption: RCW 51.04.020, 51.14.110(3).
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: L&I, governmental.
Name of Agency Personnel Responsible for Drafting: James Nylander, Program Manager, Tumwater, Washington, 360-902-6907; Implementation and Enforcement: Vickie Kennedy, Assistant Director, Tumwater, Washington, 360-902-4997.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting K. C. Wilkerson, P.O. Box 44890, Olympia, WA 98504-4890, phone 360-902-6851, fax 360-902-6977, email
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW 19.85.025(4).
Explanation of exemptions: The proposed rule is exempt under RCW 19.85.025(4) because there are not any current self-insured employers that qualify as a small business under the definition of RCW 19.85.020(3).
June 4, 2019
Joel Sacks
WAC 296-15-232Self-insurance medical bill electronic data interchange.
(1) Self-insurers are required to report medical bills incurred from their workers' compensation claims according to department guidelines.
(a) All bills associated with qualifying claims must be reported, and the department will establish a minimum threshold percentage for reporting of bill to claims to monitor compliance.
(b) Qualifying claims include claims for which:
(i) The date of injury (DOI) was on or after January 1, 2020.
(ii) The claim was initiated during a time that the employer was self-insured, and the liability for that claim remains with the employer.
(2) Self-insurers must submit complete and accurate reports based on standards set forth by the International Association of Industrial Accident Boards and Commissions (IAIABC).
(a) The department will systematically monitor report data for quality and timeliness, and establish objective performance standards based on the overall reporting of data.
(b) The department will establish a maximum threshold percentage for errors or untimely submittals.
(c) The department will provide notification to submitters if performance measures are below the standard set by the department.
(d) Submitters will have thirty days from the date of notification to make corrections to errors and resubmit, or request an extension in writing to the department.
(e) The department will review errors that remain uncorrected after thirty days. Uncorrected errors may result in training, audit, rule violation penalties, and/or a corrective action process.
(3) New self-insurers may apply for an exemption to reporting medical bills with their application for certification as a self-insured employer.
(a) To qualify for the exemption, the employer must have had one or fewer claims filed in the state of Washington in the last three years, and the employer must have fewer than five employees in the state.
(b) The department may deny any request for exemption.
(c) Authority to grant or deny exemptions belongs to the supervisor of industrial insurance, or designee.
(d) If granted, the exemption expires after three years. The employer may apply for another exemption at that time.