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
Effective June 6, 2024, E2SSB 5213 amended the definition of an HCBM. This revised definition excludes hospitals and any other entity, such as medical groups, that only perform provider credentialing or recredentialing.
This law also requires HCBMs to appoint the commissioner as its attorney to receive service of process. If you are an actively registered HCBM, you must provide a completed Service of Process form (PDF, 1.20 MB) by July 6, 2024.
HCBMs are now required to register with the Washington secretary of state. If you are not already registered, you have until July 6, 2024 to submit a copy of your certificate of registration.
Additionally, biographical affidavits for company directors and officers are no longer required.
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” do not 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. When we complete your application review, we’ll send you a registration confirmation email with an attached copy of your Certificate of Registration. Please note that you are not registered until you receive the Certificate of Registration.
If we determine you are not required to register or you withdraw your registration before approval, you can request a refund.
You will need to renew your registration by March 1 of each year.
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 will calculate renewal fees for the next registration period and make the invoices available 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 will 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. Failure to pay by July 15 may result in delayed renewal, nonrenewal or possible regulatory enforcement action.
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 do not need to register with the OIC:
- Self-insured health plans (unless the plan is PEBB or SEBB)
- Medigap plans
- Medicare Advantage plans
- Medicaid
- 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 for complete details.