Washington Balance Billing Protection


MAXIMUS Federal is an approved entity for providing arbitration services for Washington Balance Billing Protection Act (BBPA). Section 8 of the Balance Billing Protection Act (Chapter 427, Laws of 2019) directs the Office of the Insurance Commissioner (OIC) to develop a list of approved arbitrators or entities that provide arbitration for use by parties involved in balance billing disputes. The act calls for arbitrators to preside over disputes between health care providers, facilities and carriers. Here is the link to WA Office of Insurance Commissioner. This site includes a link to the Act, which outlines eligibility and requirements.


Purpose of this site

This site allows the parties in dispute to initiate arbitration with MAXIMUS once MAXIMUS is selected and confirmed by WA OIC. Only one party will electronically initiate arbitration within this MAXIMUS portal. Then, MAXIMUS will notify and request an arbitration response from the responding party within this MAXIMUS portal. Data and documents are securely transmitted and stored.

Users of this site


This site may be used by both parties in dispute (out-of-network provider/facility and carriers).


Inform WA OIC of intent to arbitrate

  • The initiating party must notify the Commissioner of its intent to seek arbitration. BBPA Arbitration Initiation Request Form
  • The parties in dispute must agree on an arbitrator from the list provided by the Commissioner.
  • If the parties do not agree on an arbitrator, they must notify the Commissioner who must provide a short list of five (5) arbitrators to choose form. Each party may veto two (2) of the five (5) named arbitrators. If one arbitrator remains, that person is the chosen arbitrator. If more than one arbitrator remains, the commission must choose the arbitrator from the remaining arbitrators.
  • The parties and the Commissioner must complete this selection process within twenty (20) calendar days from the receipt of the original list of arbitrators provided by the Commissioner.


Prepare for electronic filing

Review the filing form, click here.

  • Gather dispute data and documentation. Here’s a list of documentation:
  • All claim forms pertinent to the dispute
  • All copies of Explanation of Benefits and/or Explanation of Payments
  • Pertinent communication between out-of-network provider/facility and Carrier
  • Rationale for asserting the proposed final offer amount
  • Documentation demonstrating good faith negotiation
  • Register for an account to use this site to file electronically. Once your account has been created, log in and activate your newly created account. Newly created account must be activated within 3 calendar days.
  • Complete the online arbitration filing.


Arbitration Process

  • MAXIMUS reviews the filing to confirm filing is complete and all required documentation has been provided.
  • MAXIMUS notifies the responding party to submit their response along with required documentation.
  • MAXIMUS requests information from the parties as needed.
  • MAXIMUS will issue a written decision within thirty (30) calendar days after the receipt of the parties’ written submissions.
  • Parties may check case status at any time by logging into this site.


Arbitration Decision

  • The party that fails to make timely written submissions shall be considered to be in default. MAXIMUS shall require the party in default to pay the final offer amount submitted by the party not in default and may require the party in default to pay expenses incurred to date in the course of arbitration including the arbitrator’s expenses and fees and the reasonable attorneys’ fees of the party not in default.
  • The award decision will either be the initiating party’s final offer or the responding party’s final offer.


Arbitration Fees

The Initial Review determines whether your filing qualifies for arbitration based on the information submitted. If the filing qualifies, then the matter will go to arbitration for a decision on the case.

  • Initial Review Fee: $130 per case
  • Arbitration Fee: $235 per case

Fees are split equally between the parties.


Contact Us

Attn: WA Surprise Billing Arbitration
3750 Monroe Avenue, Suite 705
Pittsford, NY 14534

img waarb@maximus.com

imgFax: (585) 869-3388