IDR filing for Washington providers: BBPA arbitration or federal IDR

What the BBPA covers

The Legislature passed the BBPA in 2019 (Chapter 427, Laws of 2019), effective January 1, 2020. It bars balance billing for emergency services and for certain non-emergency surgical and ancillary services at in-network facilities. In 2022, ESHB 1688 aligned it with the federal No Surprises Act, extended protections to behavioral health emergency services providers, and kept the self-funded opt-in.

The payment standard

Carriers must pay out-of-network providers a commercially reasonable amount, based on payments for the same or similar services in a similar geographic area. If the parties can't agree, BBPA arbitration is final-offer: the arbitrator picks either the carrier's or the provider's number. The Insurance Commissioner publishes a data set drawn from the state all-payer claims database to inform those offers.

The self-funded opt-in

• Self-funded group plans may elect into the BBPA; roughly 390 had done so by the Commissioner's 2022 report.
• Self-funded plans cover about 500,000 people in Washington.
• Opted-in plans → BBPA arbitration. Plans that haven't opted in → federal IDR.

Volume so far

State arbitration has been small: 71 requests in 2020, of which 19 were decided in providers' favor, per the Commissioner's office. Most Washington dispute volume sits in the federal process.

What we do for Washington groups

• Check every self-funded claim against the current opt-in list before filing
• Route state-regulated and opted-in claims to BBPA arbitration and the rest to the federal portal
• Build offers from the state data set for BBPA cases and from federal determination data for IDR

FAQ

Does Washington have its own surprise billing arbitration?

Yes. The Balance Billing Protection Act provides final-offer arbitration for out-of-network payment disputes under state-regulated plans and self-funded plans that opt in.

What payment standard applies under the BBPA?

Carriers must pay a commercially reasonable amount based on payments for the same or similar services in a similar geographic area.

Do self-funded plans in Washington go to state arbitration?

Only if they have opted into the BBPA. Self-funded ERISA plans that have not opted in use the federal IDR process.

When did the Washington BBPA take effect?

January 1, 2020. It was amended in 2022 by ESHB 1688 to align with the federal No Surprises Act.

Sources: Washington Office of the Insurance Commissioner, BBPA arbitration reports (2020, 2022) and opt-in resources; Final Bill Report, ESHB 1688 (2022); OIC staff remarks reported by State of Reform. IDR Filings is not a law firm and this page is not legal advice.