AN ACT Relating to modernizing and clarifying timely payment requirements for health carriers;
Summary
SB 5845 updates Washington’s health insurance prompt-pay rules for health carriers. The bill requires carriers to pay or deny provider and facility claims within specified deadlines, generally 30 calendar days for clean claims and 60 calendar days for claims that require additional information. If a carrier needs more documentation, it must send a single notice identifying the missing information, and the claim becomes a clean claim once the requested material is received. The bill also requires carriers to provide remittance advice or electronic notice when claims are denied or need more information, and to maintain a reasonable method for confirming receipt of claims and responding to provider inquiries.
The bill adds financial consequences for late processing. Carriers must pay interest on claims they fail to process within the required timelines, with interest accruing at 1 percent per month initially and 1.5 percent per month after the delay continues beyond 30 days. The bill also authorizes administrative penalties for unresolved violations and clarifies that interest is the carrier’s responsibility and cannot be shifted to the patient’s deductible, copay, or coinsurance. It further limits when carriers may seek refunds from providers, generally requiring written requests within set timeframes and allowing exceptions for fraud, coordination of benefits, or third-party liability situations.
Impact
The bill amends Washington insurance statutes governing health carrier claims handling and timely payment, and adds a new section to chapter 48 RCW. It applies to health plans filed or renewed on or after January 1, 2027, and covers carriers regulated by the insurance commissioner, including plans offered through the public employees’ and school employees’ benefits boards. It excludes Medicaid managed care, dental-only carriers, Medicare-related coverage, and Medicare supplemental plans. The bill also defines key terms such as clean claim and remittance advice, and preserves the insurance commissioner’s enforcement authority.
Sentiment
The bill appears to have broad bipartisan support and moved through both chambers unanimously or near-unanimously, with no recorded dissenting votes in the provided history. Committee and floor votes were overwhelmingly favorable, including unanimous committee approvals and final passage votes in both the Senate and House. The overall sentiment reflected in the voting record is that the measure is a technical but important modernization of claims-payment rules intended to improve predictability for providers and patients.
Contention
No major opposition is reflected in the available committee or floor vote history, and there are no transcript snippets indicating substantive debate. The main policy issues embedded in the bill are operational rather than ideological: carriers may be concerned about tighter deadlines, mandatory interest, and limits on repeated information requests, while providers and facilities are likely to support the bill’s stronger enforcement and clearer payment timelines. The bill also draws boundaries around exceptions for fraud, emergencies, and certain plan types, which suggests the legislature sought to balance prompt payment with carrier flexibility in unusual cases.
AN ACT Relating to modernizing payment systems by expanding consumer-friendly transaction options for registered tow truck operators and regulated businesses;
AN ACT Relating to modernizing the all payers claims database by updating reporting requirements, data disclosure standards, and lead organization requirements;