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. They can include specialized benefit types, such as pharmacy, radiology, laboratory and mental health benefits.
Before you conduct business as an HCBM, you need to register with the Office of the Insurance Commissioner (OIC) and then renew your registration annually.
Recent changes to Washington’s HCBM laws and rules
ESSB 5213 modifies state law regarding the business practices of HCBMs. We updated Chapter 284-180 WAC with new rules and updated the existing rules to clarify your rights and responsibilities under the new law.
Effective January 18, 2025, the following changes will affect registration and renewals:
- You are required to report your Washington annual gross income from HCBM services provided in the previous calendar year for each contracted entity.
- The deadline to amend your reported income for the previous calendar year is April 15.
As of June 6, 2024 the following changes are now in effect:
- The definition of HCBM has been updated. The new definition excludes hospitals and other organizations, such as medical groups, that only perform provider credentialing or recredentialing.
- HCBMs must appoint the commissioner as their attorney for receiving service of process. If you haven't completed this requirement, you must submit a completed Service of Process form (PDF, 1.20 MB).
- HCBMs must register with the Washington Secretary of State. If you have not already submitted a copy of your certificate of registration, you need to include the certificate with your annual report.
Technical assistance advisories
Technical assistance advisories (TAA), or bulletins, are interpretive policy statements from our office.
- TAA 2024-01: This advisory issued on 04/16/2024 provides guidance about the duties and registration requirements of HCBMs. Read the OIC’s interpretation of Chap. RCW 48.200 and RCW 48.43.731 (PDF, 326.04 KB)
How to register as an HCBM
Registrations are valid from the certificate effective date to June 30. To register:
- Fill out the Account Creation and Request for Application form. We’ll send a confirmation email to confirm your request.
- Once your account request is approved, we’ll email you instructions for submitting your $200 registration fee.
- After you’ve paid the registration fee, we’ll send you a receipt and links to the HCBM application form and DocuSign portal where you’ll upload your application.
- Upload the completed application and all supporting documents to the DocuSign portal. Sign the application and select “Finish” to submit your application.
Please note that all information in your submission is subject to the Public Records Act and is considered a public record. Submissions marked “private” or “confidential” don't prevent them from being made publicly available.
What to expect after you submit your application
We review applications on a first-in-first-out basis. Review times vary based on the number of pending applications. nce we complete your application review, you’ll receive a registration confirmation email that includes a copy of your Certificate of Registration. You aren’t officially registered until you receive this Certificate.
If you choose to withdraw your registration before approval, you can request a refund.
You will need to renew your registration by March 1 of each year.
You must report any material changes to your registration information within thirty days. You can report these changes by email. Failure to report changes in a timely manner may result in enforcement actions.
How to renew your HCBM registration
To continue operating as an HCBM in Washington, you need to renew your registration by March 1 of each year. Renewal registrations are valid for one fiscal year from July 1 to June 30.
We calculate renewal fees for the next registration period and provide invoices by June 1. Payment is due by July 15.
To renew your registration:
- Log into the Filing and Payment Center by March 1 to access your annual gross income report.
- Use the annual gross income report to submit your Washington state gross HCBM business income and supporting documents.
- By June 1 of each year, we’ll send you an invoice notice for the renewal fee, which is a prorated share of the cost of regulating HCBMs in Washington. Once you have this notice, you can also get your invoice in the Filing and Payment Center.
- Pay your renewal fee online or mail your renewal payment with a printed invoice that includes your WAOIC number to:
Washington State Office of the Insurance Commissioner
PO Box 40255
Olympia, WA 98504-0255
The deadline for renewal fee payment is July 15. If your payment is late, your renewal could be delayed or non-renewed. You may also be subject to regulatory enforcement.
Who needs to register as an HCBM?
You need to register with the OIC as an HCBM if the services you provide directly or indirectly impact patient access to health care services, drugs and supplies.
Qualifying services include, but are not limited to:
- Prior authorization or preauthorization of benefits or care
- Certification of benefits or care
- Medical necessity determinations
- Utilization reviews
- Benefit determinations
- Claims processing and repricing
- Outcome management
- Payment or payment authorization to providers and facilities
- Dispute resolution, grievances or appeals to benefits determinations
- Provider network management
- Disease management
Please contact us if you're not sure if you need to register. Select "Company Applications" in the drop-down menu.
Who doesn’t need to register as an HCBM?
HCBMs providing services to or acting on behalf of these health plans don't need to register with the OIC:
- Self-insured health plans (unless the plan is PEBB or SEBB)
- Medigap plans
- Medicare Advantage plans
- Medicaid plans (unless you are a pharmacy benefit manager)
- Union plans
Any entity which only performs provider credentialing and recredentialing services. If you provide any additional qualifying service, you must apply for registration as an HCBM.
Plans that provide monetary payment, such as income replacement disability plans or life insurance accelerate benefits, are only exempt if they do not directly or indirectly impact patient access to health care services, drugs, and supplies.
If you service non-exempt plans in addition to exempt plans, you must apply.
See WAC 284-180-120 and WAC 284-180-500 for complete details.