(1) The authority shall provide routine and
periodic computerized information to health insurers regarding
client eligibility and coverage information. Health insurers
shall use this information to identify joint beneficiaries.
Identification of joint beneficiaries shall be transmitted to the
authority. The authority shall use this information to improve
accuracy and currency of health insurance coverage and promote
improved coordination of benefits.
(2) To the maximum extent possible, necessary data elements
and a compatible database shall be developed by affected health
insurers and the authority. The authority shall establish a
representative group of health insurers and state agency
representatives to develop necessary technical and file
specifications to promote a standardized database. The database
shall include elements essential to the authority and its
population's health insurance coverage information.
(3) If the state and health insurers enter into other
agreements regarding the use of common computer standards, the
database identified in this section shall be replaced by the new
common computer standards.
(4) The information provided will be of sufficient detail to
promote reliable and accurate benefit coordination and
identification of individuals who are also eligible for authority
programs.
(5) The frequency of updates will be mutually agreed to by
each health insurer and the authority based on frequency of
change and operational limitations. In no event shall the
computerized data be provided less than semiannually.
(6) The health insurers and the authority shall safeguard
and properly use the information to protect records as provided
by law, including but not limited to chapters 42.48, 74.09, 74.04, 70.02, and 42.56 RCW, and 42 U.S.C. Sec. 1396a and 42
C.F.R. Sec. 43 et seq. The purpose of this exchange of
information is to improve coordination and administration of
benefits and ensure that medical insurance benefits are properly
utilized.
(7) The authority shall target implementation of this
section to those health insurers with the highest probability of
joint beneficiaries.
[2011 1st sp.s. c 15 § 119; 2007 c 179 § 3; 2005 c 274 § 350; 1993 c 10 § 3.]
NOTES:
Effective date -- Findings -- Intent -- Report -- Agency transfer -- References to head of health care authority -- Draft legislation -- 2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Effective date -- 2007 c 179: See note following RCW 74.09A.005.
Part headings not law -- Effective date -- 2005 c 274: See RCW 42.56.901 and 42.56.902.