Instructions and frequently asked questions
- Network Access Reports submission instructions (PDF 549.90KB)
- Urban Counties (updated 03-30-2022) (XLSX 15.48KB)
- Frequently Asked Questions (updated 3-30-23) (PDF 514.73KB)
Templates
- Access Plan cover sheet (PDF 106.08KB)
- Alternative Access Delivery Request (AADR) – Request Form (PDF 15.83KB)
- Form C - AADR (Alternative Access Delivery Request Form C) (Updated 3-30-23) (PDF 388.61KB)
- Network Enrollment Form B Report (updated 12-1-2020) (XLSX 272.31KB)
- Provider Network Form A - AADR (XLSX 16.69KB)
Provider network form A
Note: The Provider Network Form A's National Plan and Provider Enumeration System (NPPES) data was loaded on 12/22/2025 using the NPPES file from 12/08/2025.
- Provider Network Form A instructions (updated 3-27-2025) (PDF 647.25KB)
- Provider Network Form A FAQ (updated 5-12-22) (PDF 306.62KB)
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:
- April 5, 2026
- July 5, 2026
- October 5, 2026
- January 5th, 2027
- 988 Crisis Hotline Form D report (XLSX 47.84KB)
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.
- Request to Open Portal (PDF 1.19MB)
- Amended Alternate Access Delivery Request Form E (PDF 1.08MB)
- Amended Alternate Access Delivery Request Contact Log (PDF 107.28KB)
Analyst checklists
- Network Access Reports (updated 3-30-23) (DOCX 75.67KB)
- Analyst Checklist Provider and Facility Agreements (updated 7/1/2024) (DOCX 73.00KB)
- Analyst Checklist Single Case Provider and Facility Agreements (updated 7/1/2024) (DOCX 67.10KB)
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.
- General notice for contract termination (ed 12012025) (DOCX 32.63KB)
- Carrier notice for contract termination (ed 12012025) (DOCX 37.60KB)
- Carrier notice for expiring contract (ed 12012025) (DOCX 36.79KB)
- Providers notice for contract termination (ed 12012025) (DOCX 37.48KB)
- Providers notice for expiring contract (ed 12012025) (DOCX 35.53KB)
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.