Consumers

For each arbitration proceeding they oversee, the arbitrator must submit to our office:

1. The applicable reporting form; and
2. Their written decision

Reporting forms (Appendix B or Appendix C)

There are two arbitrator decision reporting forms, referred to as Appendix B and Appendix C. A brief description is provided below to assist you in determining which form is the appropriate one to use.

Once you have determined the appropriate form, there are two ways to submit:

• Submit the information online, or

• Download and print the hardcopy form. After completing it, submit it via the contact the arbitration team form. (If you use this option, the form and your decision can be uploaded at the same time).

Arbitrator decision reporting form - “Appendix B”

The arbitrator decision reporting form is required for arbitration proceedings under RCW 48.49.040. This mandatory form for arbitrators to use is referred to as “Appendix B” in WAC 284-43B-037(6)(b) and WAC 284-43B-090. This form assists the OIC with its annual reporting requirements under RCW 48.49.050.  Submission of this form and the written decision satisfies the notification requirements under RCW 48.49.040(8)(a). Note: Appendix B cannot be used for arbitration decisions under RCW 48.49.135.

• Arbitrator decision reporting form

• Arbitrator Decision Reporting Form (PDF 257.34KB)

Arbitrator reporting form for proceedings under RCW 48.49.135 – "Appendix C"

The arbitrator decision reporting form is required for arbitration proceedings under RCW 48.49.135. This mandatory form for arbitrators to use is referred to as “Appendix C” in WAC 284-43B-037(6)(b) and WAC 284-43B-095. The form assists the OIC with its annual reporting requirements under RCW 48.49.050. Submission of this form and the written decision satisfies the reporting requirements under RCW 48.49.040(8)(a). 

• Arbitrator decision reporting form for arbitration proceedings under RCW 48.49.135

• Arbitrator decision reporting form for arbitration proceedings under RCW 48.49.135 (PDF 236.46KB)

The written decision

Arbitrators’ decision

RCW 48.49.040 lists the factors the arbitrator must consider in choosing one of the parties’ final offer amount. The arbitrator’s decision must include:

• Explanation of the elements of the parties' submissions the arbitrator relied upon to make their decision and
• Why those elements were relevant to their decision. 

What are the formatting guidelines?

There is no template or form for the written decision. We recommend that the decision:

• Be in a Word of PDF document file
• Header includes the parties' names and the arbitration initiation request form number

Arbitrator fees

Arbitrator fees must be paid by the parties within 30 calendar days of receipt of the arbitrator's decision. If the parties reach an agreement before the arbitrator makes their decision, any arbitrator fees must be paid by the parties within 30 calendar days of the date the settlement is reported to the OIC.

How to submit the written decision

The final written decision must be submitted to the arbitration team form.

Settlements before the final decision

If the parties settle before the arbitrator has decided, the parties must submit a settlement reporting form to the OIC. The arbitrator is not required to submit information about the parties’ settlement to the OIC.

How to submit an arbitration request form (Appendix A)

A health care provider, facility or health insurer can submit this Arbitration Initiation Request Form (AIRF) if the following is true:

• You are submitting this on behalf of a carrier, provider, or facility initiating arbitration under the Balance Billing Protection Act (BBPA). 
• The AIRF is submitted no later than 10 calendar days following the completion of the period of good faith negotiation.
• The most recent payment for the service in dispute was in the last 40 days. 
• The patient’s plan is regulated by the Office of the Insurance Commissioner (OIC) or is a self-funded group health plan that has elected to participate in the BBPA.
• The email address for the non-initiating party you are providing for the other party has been verified and is correct - Health plan arbitration contact information.
• You are not submitting any identifiable patient information with the AIRF. 
• You have read all the instructions on this page, including the notice requirements to the non-initiating party. 

Steps to initiate arbitration

1. Complete and submit the arbitration initiation request form
2. Email a copy of the confirmation page to the non-initiating party. Both of these steps must be completed by the initiating party.

Each submission is a distinct arbitration proceeding 

After you have gone through the screening steps and provided basic information about the parties, you will be asked to describe the health care services at issue and to complete the health care provider’s information. This information must be completed for each claim.

How to bundle claims into a single arbitration proceeding

Claims can be bundled in a single arbitration request. You may bundle up to 20 claims in a single filing if all the claims involve the same carrier and provider or facility, all have the same procedural code (or a comparable code under a different procedural system) and all occur within the same 30 business day period.

To submit bundled claims, select the number of claims being bundled on the health care provider information screen. The required information must be submitted for each claim. The form will not allow you to complete your submission without the required information for each claim. No additional documents can be uploaded.

How to print the confirmation page and send notice to the other party

The law requires that any information submitted to the OIC with the arbitration initiation request must be included in the notice to the non-initiating party. The party initiating the arbitration must provide written notification to the non-initiating party. To ensure that the non-initiating party receives all necessary information, OIC strongly encourages the initiating party to send a copy of the confirmation page (a copy of their completed arbitration initiation request form) to the non-initiating party’s verified email address to meet the notification requirement. 

To print the completed AIRF, select the “Submit” button. The completed form will display a confirmation screen. You will need to print this as a .PDF document. On most systems, this is done by right-clicking with your cursor and selecting “Print…” and then printing as .PDF. If your system does not have this capability, you may also take screenshots and save them as .JPEG or .GIF images that would be attached to the email notification to the non-initiating party. 

IMPORTANT: Do not exit out of the confirmation page before you have printed it. Once it has been closed, you will not be able to return to the confirmation page and will need to resubmit your AIRF. 

OIC encourages the initiating party to send electronic notification to the non-initiating party shortly after submission of the AIRF to OIC.

DO NOT copy the OIC BBPA arbitration team on the email notification to the non-initiating party. If the non-initiating other party claims they did not receive timely notice from you, they can raise that issue with the arbitrator at which time you will be required to show proof that timely notice was sent. 

What happens next

Within seven calendar days, the OIC BBPA arbitration team (through the OIC Administrative Hearings Unit) will conduct a review of your arbitration initiation request form and contact you. If your request was timely submitted and complete, the OIC will provide both parties with a unique number or designation for your arbitration initiation request (“AIRF Number”) as well as a link to the list of approved arbitrators or entities providing arbitration services. 

The parties must include the AIRF number in all communication related to that request. A party seeking to challenge whether a claim is eligible, appropriately bundled, etc., may raise those issues during arbitration.

Once that notification to the parties has been sent from the OIC BBPA Arbitration Team, the parties have 5 calendar days to notify the OIC of their selection of the arbitrator or to request a narrowed list of 5 arbitrators. If the parties still cannot agree, one will be assigned by the OIC from the narrowed list. 

Learn more about the BBPA arbitrator Arbitration selection process and the parties’ nondisclosure agreement.

Within ten business days of a party notifying OIC and the non-initiating party of the intent to initiate arbitration, both parties must agree to and execute a nondisclosure agreement. 

The timeframe for corrections and resubmissions

Except for typographical errors, any corrected AIRFs also must be submitted within 10 calendar days of the submission of the original request. A party that has submitted an untimely notice is permanently foreclosed from seeking arbitration related to the claim or claims that were the subject of the untimely notice.

Do you have an accessibility or accommodation request?

The law requires that this form be submitted electronically through the OIC’s website. If you have a disability and require assistance or accommodation, please contact the OIC BBPA arbitration team.

To learn more about the Balance Billing Arbitration Act and arbitration process.

Three primary documents which define and guide in our relationship with tribal leadership, as well as a Memorandum of Agreement with some tribes.

The 1989 Centennial Accord

This relationship is established to enhance and improve communication and to facilitate issue resolution. The accord also commits the parties to tasks that will translate to “more efficient, improved and beneficial services to Indian and non-Indian people” and encourages and provides for agreements “to address or resolve specific issues.”

Government-to-government relationship with Indian tribes

Chapter 43.376 RCW requires us to:

• Make reasonable efforts to collaborate with tribes in development of policies, agreements, and program implementation that directly affect tribes, including requirements to offer consultation with tribes on certain actions.
• Designate a tribal liaison who reports directly to the Commissioner as head of our agency.
• Ensure liaisons and executive staff receive training according to this chapter.
• Submit an annual report to the governor on implementation of this chapter and activities of the OIC involving tribes.

Policy 5, OIC Tribal consultation and collaborative process

This policy, established based on the Centennial Accord and Chapter 43.376 RCW, provides general requirements and specific procedures for engaging with tribal leadership. It also provides a sample consultation letter, tribal party response form, and a list of Indian tribes, Urban Indian Health Programs, and Organizations for Consultation.

• Policy 5 OIC Tribal consultation and collaborative process (PDF 2.69MB)

Contact information for agency Tribal Liaison

Larry Robinette, Tribal Liaison

• Call: 360-725-9634
• Email: OIC Tribal Liaison

Compliant with the Interlocal Cooperation Act (RCW 39.34), all current agreements between the Office of Insurance Commissioner (OIC) and another state, federal or governmental entity are provided below. To review any agency agreements, please follow the public records request process.

The details below are accurate as of March 13, 2024.