What is Washington Prior Authorization Law?
Washington HB 1701 (2022), codified in RCW 48.49.050, requires insurers to respond to standard prior authorization requests within 72 hours and urgent/expedited requests within 24 hours. Electronic PA portals are mandatory by 2027, improving provider and patient access. Washington HB 1128 (2023) further prohibits insurers from making PA denials based solely on artificial intelligence without human clinical review.
Response Timelines
- Standard PA requests: response within 72 hours
- Urgent or expedited PA requests: response within 24 hours
- Emergency services: PA not required; retrospective review allowed
AI-Only Denials Prohibited
Under Washington HB 1128 (effective July 1, 2023), insurers cannot deny a PA request based solely on an artificial intelligence determination. Every PA denial must include human clinical review and must cite the specific clinical criteria that support the denial.
Denial Notice Requirements
When a PA request is denied, the insurer must provide a written notice that includes the specific clinical criteria used to support the denial. Denials cannot be based solely on the absence of clinical information if the insurer did not first request that information from the provider.
Appeal and Review Rights
- Internal appeal: 30 days from denial notice
- External review: independent clinical review available through the Office of the Insurance Commissioner
- Expedited external review: available for urgent situations
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Frequently Asked Questions
Can a Washington insurer require prior authorization for emergency services?
No. Washington law exempts emergency services from prior authorization requirements. Insurers may conduct retrospective review after emergency care is provided, but cannot delay or deny emergency treatment by requiring advance prior authorization.
How long does Washington give me to appeal a denied prior authorization?
Washington gives patients 30 days from the PA denial notice to file an internal appeal. If the internal appeal is denied, independent external review through the Office of the Insurance Commissioner is available.
How to Appeal a Denied Prior Authorization in Washington
- Obtain the denial letter with clinical criteria cited — Request your insurer provide a written explanation of the specific clinical criteria used to deny your prior authorization request.
- Gather supporting clinical documentation — Collect physician notes, lab results, imaging reports, and other clinical evidence demonstrating the medical necessity for the requested service.
- File an internal appeal within 30 days of the denial — Submit your appeal to your insurance company, including the clinical documentation and a detailed explanation of why the treatment is medically necessary.
- Request independent external review through the Office of the Insurance Commissioner — If your internal appeal is denied, contact the OIC to request independent external review by a neutral third-party clinical reviewer.
Disclaimer: State laws change. This reference is current as of April 13, 2026. Consult Washington RCW 48.49.050, HB 1128, or a healthcare attorney for definitive guidance on your specific situation.