Enrollment Data Transfer to Washington Health Care Authority

Premera is legally required to provide enrollment data to state Medicaid agencies when requested in order to facilitate coordination of benefits. This requirement is for fully insured and self-funded plans (including OptiFlex) enrollment data.

The Washington Healthcare Authority has requested three years of enrollment data and ongoing monthly enrollment data feeds. Premera will begin providing this data in May 2026.

What you need to know

Federal and state laws require Premera to provide enrollment data to state Medicaid agencies.

• The Deficit Reduction Act of 2005 and related state laws require TPAs to provide self-funded and fully insured enrollment data to state Medicaid agencies.
• Medicaid agencies use the enrollment data to identify dual enrollees in order to reduce Medicaid fraud, waste, and abuse.

What happens next

Premera will provide enrollment data for the last three years and an ongoing monthly enrollment data feed.

The Healthcare Authority is required to apply HIPAA protections to the enrollment data.

• HCA is a HIPAA covered entity. It’s required to comply with HIPAA and has agreed to do so.
• HCA has agreed to promptly destroy enrollment data received for Premera members who are not dual-enrolled in Medicaid.

Contact your Premera account representative for more information.