43.371.005 – Findings.

RCW 43.371.005 Findings. The legislature finds that: (1) The activities authorized by this chapter will require collaboration among state agencies and local governments that are involved in health care, private health carriers, third-party purchasers, health care providers, and hospitals. These activities will identify strategies to increase the quality and effectiveness of health care delivered in […]

43.371.010 – Definitions.

RCW 43.371.010 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) “Authority” means the health care authority. (2) “Carrier” and “health carrier” have the same meaning as in RCW 48.43.005. (3) “Claims data” means the data required by RCW 43.371.030 to be submitted to the database, including […]

43.371.020 – Statewide all-payer health care claims database—Selection and duties of lead organization—Certification as qualified entity pursuant to 42 C.F.R. Sec. 401.703(a)—Contract with data vendor.

RCW 43.371.020 Statewide all-payer health care claims database—Selection and duties of lead organization—Certification as qualified entity pursuant to 42 C.F.R. Sec. 401.703(a)—Contract with data vendor. (1) The office shall establish a statewide all-payer health care claims database. On January 1, 2020, the office must transfer authority and oversight for the database to the authority. The […]

43.371.030 – Submission of claims data to database—Annual status report.

RCW 43.371.030 Submission of claims data to database—Annual status report. (1) The state medicaid program, public employees’ benefits board programs, school employees’ benefits board programs beginning July 1, 2020, all health carriers operating in this state, all third-party administrators paying claims on behalf of health plans in this state, and the state labor and industries […]

43.371.040 – Claims data and database—Exempt from public disclosure—Not subject to subpoena or compulsory process.

RCW 43.371.040 Claims data and database—Exempt from public disclosure—Not subject to subpoena or compulsory process. (1) The claims data provided to the database, the database itself, including the data compilation, and any raw data received from the database are not public records and are exempt from public disclosure under chapter 42.56 RCW. (2) Claims data […]

43.371.050 – Availability of claims or data for retrieval—Confidentiality of claims or data—Duties of the lead organization and the data vendor.

RCW 43.371.050 Availability of claims or data for retrieval—Confidentiality of claims or data—Duties of the lead organization and the data vendor. (1) Except as otherwise required by law, claims or other data from the database shall only be available for retrieval in processed form to public and private requesters pursuant to this section and shall […]

43.371.060 – Health care data reports—Public comment period—Preparation—Contents—Publication or release of reports.

RCW 43.371.060 Health care data reports—Public comment period—Preparation—Contents—Publication or release of reports. (1)(a) Under the supervision of and through contract with the authority, the lead organization shall prepare health care data reports using the database and the statewide health performance and quality measure set. Prior to the lead organization releasing any health care data reports […]

43.371.070 – Rules.

RCW 43.371.070 Rules. (1) The director shall adopt any rules necessary to implement this chapter, including: (a) Definitions of claim and data files that data suppliers must submit to the database, including: Files for covered medical services, pharmacy claims, and dental claims; member eligibility and enrollment data; and provider data with necessary identifiers; (b) Deadlines […]

43.371.080 – Cost, performance, and effectiveness of database and performance of lead organization—Reports to the legislature.

RCW 43.371.080 Cost, performance, and effectiveness of database and performance of lead organization—Reports to the legislature. (1) The authority shall report every two years to the appropriate committees of the legislature regarding the cost, performance, and effectiveness of the database and the performance of the lead organization under its contract with the authority. Using independent […]

43.371.090 – State agency coordinating structure—Biennial review—Recommendations.

RCW 43.371.090 State agency coordinating structure—Biennial review—Recommendations. (1) To ensure the database is meeting the needs of state agencies and other data users, the authority shall convene a state agency coordinating structure, consisting of state agencies with related data needs and the Washington health benefit exchange to ensure effectiveness of the database and the agencies’ […]

43.371.100 – Development of data set and business process to assist in determining commercially reasonable payment amounts and resolving out-of-network payment disputes for medical services covered under the balance billing protection act.

RCW 43.371.100 Development of data set and business process to assist in determining commercially reasonable payment amounts and resolving out-of-network payment disputes for medical services covered under the balance billing protection act. (1) The office of the insurance commissioner shall contract with the state agency responsible for administration of the database and the lead organization […]