Instructions and frequently asked questions

Templates

Provider network form A

Note: The Provider Network Form A's National Plan and Provider Enumeration System (NPPES) data was loaded on 5/15/2026 using the NPPES file from 5/11/2026.

Provider network form A report and license prefix changes

We are aware that the Department of Health (DOH) updated its providers’ licensure credential format in March 2026. This change adds a new credential type prefix and special characters to the prior credential prefix licensure number. These new license types do not meet the current Provider Network Form A report format requirements in Record Type 1, Field 5 (Provider Network Form A Data File Specification (PDF 647.25KB)).

We are reviewing information from the DOH about this new format. Any changes to the Record Type 1, Field 5, and the validation of this field will be shared with updated guidance. Health carriers filing the Provider Network Form A report must continue to follow the current format outlined in the data specification file (updated March 27, 2025), which is: XX00000000 (2 alpha, 8 numeric).

Do not file using the credential type prefix or any combination of special characters (XXXX.XX.00000000)

 

We are extending the May 5, 2026, Provider Network Form A report filing deadline to May 10 to allow health carriers time to review and update submissions.

For questions, contact our team by email at OICNetworkAccess@oic.wa.gov.

988 crisis hotline appointment form D

You must file the 988 Crisis Hotline Appointment D report if you're a disability insurer, health care service contractor (HCSC) or health maintenance organization (HMO) that will be issuing or renewing a health plan after Jan. 1, 2023. Please see RCW 48.43.790 and WAC 284-170-280(3)(c) for more information.

The first report for calendar year 2025 is due Jan. 5, 2025. After that, reports are due monthly by the 5th of each month (i.e. Feb. 5, 2025).The last report for plan year 2025 is due January 5, 2026.

For plan year 2026, the reporting requirements will change from monthly to quarterly.  The reports are due:  

Amended alternate access delivery request form E

An issuer that meets the criteria in RCW 48.49.135(2)(b) may submit an amended alternate access delivery request (AADR) for review and approval. The issuer must submit a request to open the filing portal following the instructions on the form. The submission must include the: Amended Alternate Access Delivery Request Form E, Amended AADR Contact Log form, and supporting documentation.

Analyst checklists

System for Provider Network Review and Response (SPNRR)

Enrollee and patient standard template notices for expiring or terminating provider contracts

Health carriers, health care providers, and health care facilities must use standard template language for notices sent to health plan enrollees and patients when a provider contract is expiring by its own terms or when one party has given notice to the other party of an intended termination without cause. [RCW 48.43.732]

The insurance commissioner’s office (OIC) has developed the following five (5) standard templates that may be used by health carriers, health care providers, and health care facilities.  Notices sent to enrollees or patients that solely utilize one of the following templates do not require review or approval by the OIC.

Any notice to an enrollee that does not utilize the template language in full or adds or revises the language of the above templates must be reviewed and approved by the OIC before being used in any manner.

To submit an enrollee or patient notice to the OIC for review, email them to OICNetworkaccess@oic.wa.gov with the subject line “Enrollee/Patient notice for review per RCW 48.43.732”  Your email must identify if you are a health carrier, health care provider, or health care facility.   

General questions about this requirement or how to use the templates may be directed to Jennifer Kreitler, Provider Network Oversight Program Manager at Jennifer.Kreitler@oic.wa.gov.

Login