Washington State Senate Bill 5346

"An act relating to establishing streamlined and uniform administrative services for payors and providers"

In the 2009 session, the Washington State Legislature passed and Governor Gregoire signed Senate Bill 5346 designed to streamline and standardize administrative interactions between payers and providers.

The bill, supported by the Washington Healthcare Forum and many other private sector constituents, calls for the Insurance Commissioner to appoint a private sector organization to lead implementation work. In early May of this year, Commissioner Kreidler asked the Washington Healthcare Forum and OneHealthPort to continue their longstanding public service in the area of administrative simplification and lead implementation of 5346. The Forum and OneHealthPort accepted the Commissioner's invitation and designated the WorkSMART Institute to tackle the task.

Passage of 5346 accelerates administrative simplification in Washington State. The bill gives the private sector first crack at streamlining provider/payer interactions through voluntary adoption of best practices. However, if voluntary adoption proves unsuccessful, the bill gives the Insurance Commissioner the authority to write regulations and mandate universal adoption of best practices by providers and payers in Washington State. Highlights of the bill include adoption by 12/31/10 of:

• A uniform process for electronic provider credentialing
• An enhanced eligibility transaction (eligibility with rich benefits detail)
• National correct coding initiative (NCCI) edit policy by plans and providers
• Requirements for plans to consider extenuating circumstances and adhere to timeliness standards in processing requests for pre-authorization
• A browser-based tool by plans to facilitate pre-authorization requests from providers
• Other best practices

The bill's provisions apply to public and private payers, hospitals, physician practices and many other types of providers.

Below are a variety of useful references about the Administrative Simplification Bill:

• A copy of the Bill itself (PDF format)
  
• A list of the Best Practice Recommendations developed by OneHealthPort to guide implementation of the bill's provisions by payers and providers. If you are interested in participating in a Administrative Simplification Stakeholder group that helps develop the Best Practices click here to join a Stakeholder Group.
• An adoption matrix that describes the intent of payers and providers to voluntarily adopt Best Practice Recommendations
• Collateral that describes the bill (PDF)