WSR 11-09-028




[ Insurance Commissioner Matter No. R 2011-06 -- Filed April 14, 2011, 7:08 a.m. ]

Subject of Possible Rule Making: Standards for coordination of benefits (COB), definition of "allowable expense," WAC 284-51-195(1).

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.21.200, 48.44.050, and 48.46.200.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Due to recent changes to electronic (HIPAA) claims standards adopted by the Department of Health and Human Services (HHS), effective January 1, 2012, the provision of the current COB rule that requires secondary payers to use the highest allowable expense in making their payments may create significant new administrative costs and complexity for health care providers and health carriers.

The department will explore whether it would be possible to amend the COB rule definition of allowable expense in a manner that would reduce administrative costs and complexity of complying with the new HIPAA transaction standards, without having a negative impact on consumers/patients.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: No other federal or state agencies regulate this subject. However, HHS adopts the standards that apply to electronic health care transactions (HIPAA standards), which impact what health carriers and providers can do to electronically process claims.

Process for Developing New Rule: Submit written comments by June 3, 2011.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Pete Cutler, P.O. Box 40258, Olympia, WA 98504-0258,

April 14, 2011

Mike Kreidler

Insurance Commissioner

Washington State Code Reviser's Office