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.

Milestones with due dates

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.

Milestones with due dates

Additional data submission information

Data suppliers can log into the Onpoint Claims Data Manager  to access submission documentation and details.

Waiver/Exception/Extension Process