Washington Office Of The Insurance Commissioner Prior Authorization Lookup
- Washington Office Of The Insurance Commissioner coverage criteria
- All Washington Office Of The Insurance Commissioner policy updates
Latest Washington Office Of The Insurance Commissioner prior authorization updates10
- Prior AuthClinical/Medical PolicyEff. 2025-07-27Mental health and substance use disorder coverage and utilization review requirementsState statute (ESHB 1432) updates parity, defines medical necessity and clinical review criteria, prohibits prior authorization for initial evaluation + up to 6 visits in a new episode, and sets prior authorization timelines and API requirements.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-27Prior Authorization Modernization - Implementation of E2SHB 1357 (2023)Governs adoption and implementation of amendments to Washington Administrative Code Chapter 284-43 Subchapter D to implement E2SHB 1357 (2023), affecting carriers and other entities that administer prior authorization for health care services and prescription drugs in Washington state.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-12-27Prior authorization and drug utilization review (DUR) rules (Chapter 284-43 WAC)Sets Washington state administrative requirements for prior authorization processes and prescription drug utilization review programs for health benefit plans, limited health care contracts, and stand-alone dental and vision plans; affects carriers, their vendors/contractors, participating providers, pharmacies, and enrollees in Washington.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-01-01Implementation of Engrossed Second Substitute House Bill 1357: Modernizing the Prior Authorization ProcessGuidance to health carriers on RCW 48.43.830 (E2SHB 1357) requirements for prior authorization timelines, communication, clinical review standards, and API/IEP automation; applies to carriers offering health plans as defined in RCW 48.43.005.All Washington Office of the Insurance Commissioner updates
- Prior AuthClinical/Medical PolicyEff. 2021-04-01Access to Inpatient Substance Use Disorder Treatment Under RCW 48.43.761 — Technical Assistance AdvisoryGuidance to health carriers on interpretation and implementation of RCW 48.43.761 regarding prior authorization and coverage for initial inpatient, residential, and withdrawal management substance use disorder treatment in Washington state.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyComments on CR 102 (R 2024-03) Prior Authorization Modernization — Coordinated Care CorporationA submitted comment letter from Coordinated Care Corporation requesting clarification about how WAC 284-43-2020 applies to prescription drug utilization management timelines under the proposed prior authorization modernization rule.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyComments on R2024-03: Prior Authorization Modernization and SUD TreatmentComments from Kaiser Permanente to the Washington Office of the Insurance Commissioner regarding the prepublication draft rule R 2024-03 on prior authorization modernization and substance use disorder treatment; intended for the OIC rulemaking record and stakeholders affected by the rule.All Washington Office of the Insurance Commissioner updates
- Prior AuthClinical/Medical PolicyMental Health Parity — Draft WAC 284-43 (Utilization Review and Parity Requirements)Draft Washington OIC rule defining parity, utilization review, prior authorization, drug utilization review, NQTL comparative analysis, level-of-care placement, and network adequacy requirements for mental health and substance use disorder benefits under state law.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyPreproposal Statement of Inquiry: Prior Authorization Modernization and Substance Use Disorder TreatmentThis document is a preproposal statement of inquiry about updating prior authorization rules and substance use disorder treatment authorization for commercial plans regulated by the agency.All Washington Office of the Insurance Commissioner updates
- Prior AuthAdministrative/Operational PolicyPrior Authorization Modernization — Implementation of E2SHB 1357 (Prior authorization timelines and program requirements)Proposed amendments to WAC Chapter 284-43 Subchapter D to implement RCW 48.43.830, updating prior authorization time frames and clarifying applicability and processes for health plans, prescription drugs, and limited benefit plans; affects carriers, issuers, providers, pharmacies, and participating facilities operating under Washington law.All Washington Office of the Insurance Commissioner updates
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Tool Description
Search Washington Office Of The Insurance Commissionerprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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