Bill > HB2546

This bill standardizes the requirements for health insurance carriers, referred to as "carriers," to recover overpayments made to healthcare providers. Specifically, it amends existing law to shorten the timeframe within which a carrier can request a refund for a payment previously made to a provider. Under the proposed changes, a carrier generally must request a refund in writing within six months of making the payment, a significant reduction from the previous twenty-four months for most services and thirty months for mental health and substance use disorder services. For refunds related to coordinating benefits with another payer, the new timeframe is nine months. The bill also clarifies that any refund request must explain why the provider owes the money, and if a provider doesn't contest the request within thirty days, it's considered accepted. There are exceptions for fraud and situations where a third party is legally responsible for the claim. The bill defines "refund" as the return of payment, either directly or through an offset of future payments, and clarifies that it doesn't affect a carrier's ability to recover funds from a patient if they weren't entitled to benefits. The changes are set to take effect on January 1, 2027.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=2546&Year=2025&Initiative=false