For Insurers

Registering as a health care benefit manager (HCBM)

Effective Jan. 1, 2022, health care benefit managers (HCBMs) will be required to register with the Washington state Office of the Insurance Commissioner.

Who is required to register as an HCBM?

A health care benefit manager is any person or entity that provides services to or acts on behalf of a health carrier or employee benefits program. HCBMs directly or indirectly impact the determination or use of benefits for or patient access to health care services, drugs and supplies.

HCBMs include, but are not limited to, specialized benefit types such as pharmacy, radiology, laboratory and mental health.

The services of an HCBM also include:

  • Prior authorization or preauthorization of benefits or care
  • Certification of benefits or care
  • Medical necessity determinations
  • Utilization review
  • Benefit determinations
  • Claims processing and repricing for services and procedures
  • Outcome management
  • Provider credentialing and re-credentialing
  • Payment or authorization of payment to providers and facilities for services or procedures
  • Dispute resolution, grievances or appeals relating to determinations or utilization of benefits
  • Provider network management
  • Disease management

Who does not need to register as an HCBM?

This new law does not apply to the actions of health care benefit managers providing services to or acting on behalf of:

  • Self-insured health plans
  • Medicare/Medicare Advantage plans
  • Medicaid 
  • Union plans

Requirements of HCBMs are found under RCW 48.200 (leg.wa.gov) and WAC 284-180 (leg.wa.gov).

We anticipate accepting applications for HCBMs in July 2021.

Prior to accepting applications, the OIC will host an HCBM registration demonstration Zoom meeting at 3:00 pm on Tuesday, June 29th. If interested, please join our meeting.

The Office of the Insurance Commissioner will accept documents notarized via remote online notarization (RON). However, this method of notarization may only be performed by state authorized remote online notaries who employ audio/video means for identification and notarize documents using tamper-evident technologies. The notary stamp must also be a digital image that appears in the likeness or representation of a traditional notary stamp and indicates the notarization was performed via remote online methods. 

 Please check this webpage for updates on registering as an HCBM. For more information, please contact us.