Data Submission Program
Data Submission Program
All health carriers operating in Washington state must submit claims to the WA-APCD, as well as state Medicaid plans, public-employee benefits plans, third-party administrators paying claims on behalf of health plans, and the Washington State Labor and Industries program (RCW 43.371.030). Self-funded employer-sponsored plans and Taft-Hartley trust health plans may submit claims data on a voluntary basis. Submitters are organized into two reporting groups, Group 1 and Group 2.
Group 1 data submitters
Group 1 submitters include commercial health insurers, Medicaid managed care organizations (MCOs), Medicare Advantage plans, and Medicare Part D drug plans for Medicare Advantage enrollees. Data will also be supplied for persons covered under the Health Care Authority Public Employees Benefits Board (PEBB) and Medicaid fee-for-service programs.
Group 2 data submitters
Group 2 submitters include stand-alone dental insurers, the Washington State Labor and Industries program (workers’ compensation), voluntary submitters (self-funded and others), and commercial insurers not included in Group 1.
Additional data submission information
Data suppliers can log into the Onpoint Claims Data Manager to access submission documentation and details.
Exemption request process
As described in WAC 82.75.060 and 82.75.080, the Office of Financial Management (OFM) may grant data suppliers exemptions to a reporting requirement.
Submitters may apply for three kinds of exemptions:
- Waiver: data supplier is exempted from complying with a reporting requirement for a defined period not to exceed one reporting year
- Extension: data supplier receives additional time (not to exceed one reporting quarter) to submit a quarterly data submission or data resubmission requirement
- Exception: data supplier is approved to file historical data for a period less than the period specified in rule
The exemption procedure and application form are available below as of February 1, 2017; data suppliers also can obtain these materials via the Onpoint Claims Data Manager portal. See the exemption procedure for detailed instructions and submission deadlines.
Complete applications will be reviewed by OFM and a written response provided to applicants within 30 days of receipt for waivers and exceptions and 15 days for extensions. Submitters may request administrative review of denied applications within 30 days of receiving OFM's decision. Denials at administrative review may be appealed to an administrative law judge through the Office of Administrative Hearings.