Bill > SB5845

This bill aims to modernize and clarify the rules for how quickly health insurance companies, referred to as "health carriers," must pay healthcare providers and facilities for services rendered to their members. It establishes new requirements for timely payment, defining a "clean claim" as a claim without any errors or missing information that would prevent payment. Carriers must pay or deny a clean claim within 30 calendar days of receiving it. If a claim is not clean, the carrier must notify the provider within 21 days, either denying the claim with specific reasons or requesting all necessary additional information in a single request. Once all requested information is received, the claim is considered clean and must be paid or denied within 30 days. The bill also mandates that carriers pay interest on late payments, with the interest rate increasing after 60 days of non-compliance, and this interest cannot be passed on to patients. Furthermore, carriers are held responsible for the actions of any entities working on their behalf, and the bill includes exceptions for situations like fraud, acts of God, or cybersecurity attacks. These new rules will apply to health plans filed or renewed on or after January 1, 2027, and specifically target health carriers regulated by the commissioner, as well as plans offered through the public and school employees' benefits boards, but will not apply to Medicaid managed care plans.

Budget and Finance, Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5845&Year=2025&Initiative=false