Health carriers & providers

AN ACT Relating to promoting transparency and efficiency in 1
health carrier relations with health care providers and facilities; 2
amending RCW 48.43.750; and adding a new section to chapter 48.43 3
RCW. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
Sec. 1. RCW 48.43.750 and 2020 c 4 s 1 are each amended to read 6
as follows: 7
(1)(a) A health carrier must use the database selected pursuant 8
to RCW 48.165.035 to accept and manage credentialing applications 9
from health care providers. A health carrier may not require a health 10
care provider to submit credentialing information in any format other 11
than through the database selected pursuant to RCW 48.165.035.12
(b) ((Effective June 1, 2018, a health carrier shall make a 13
determination approving or denying a credentialing application 14
submitted to the carrier no later than ninety days after receiving a 15
complete application from a health care provider.16
(c))) Effective June 1, 2020, a health carrier shall make a 17
determination approving or denying a credentialing application 18
submitted to the carrier no later than ((ninety)) 90 days after 19
receiving a complete application from a health care provider. All 20
determinations made by a health carrier in approving or denying 21
H-3192.1
HOUSE BILL 2683
State of Washington 69th Legislature 2026 Regular Session
By Representative Rule
Read first time 01/27/26. Referred to Committee on Health Care &
Wellness.
p. 1 HB 2683
credentialing applications must average no more than ((sixty)) 60 1
days. 2
(c) Effective January 1, 2027, a health carrier shall make a 3
determination approving or denying a credentialing application 4
submitted to the carrier no later than 30 days after receiving a 5
complete application from a health care provider.6
(d) This section does not require health carriers to approve a 7
credentialing application or to place providers into a network.8
(2) This section does not apply to health care entities that 9
utilize credentialing delegation arrangements in the credentialing of 10
their health care providers with health carriers. 11
(3) For purposes of this section, "credentialing" means the 12
collection, verification, and assessment of whether a health care 13
provider meets relevant licensing, education, and training 14
requirements. 15
(((4) Nothing in this section creates an oversight or enforcement 16
duty on behalf of the office of the insurance commissioner against a 17
health carrier for failure to comply with the terms of this 18
section.))19
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 20
RCW to read as follows: 21
(1) A health carrier shall provide access to all billing and 22
health plan coverage information to all health care providers and 23
entities, including nonparticipating providers and facilities, in 24
order to allow all providers and entities to obtain timely 25
information on patient eligibility and required information and 26
processes to submit claims for reimbursement. Access to this 27
information must be provided through a centralized location available 28
on the health carrier's website or a website operated by the carrier 29
that is available without requiring login. 30
(2)(a) All coverage, claims, and billing documents necessary for 31
a provider or facility to determine coverage of services for an 32
enrollee, required approval or documentation for a claim, or other 33
information necessary to obtain reimbursement for a provided service 34
must be posted as required in subsection (1) of this section. This 35
includes all billing guides, payment policies, billing procedures and 36
standards, administrative rules, medical necessity guidelines, prior 37
authorization requirements, clinical review criteria, retrospective 38
p. 2 HB 2683
review processes, claims processing and claims submission 1
requirements, and similar policies, guidelines, and standards.2
(b) Carriers shall compile the documents required under this 3
subsection in a user-friendly manner. 4
(3) Health carriers shall consciously note any modifications to 5
any of the documents required to be posted under subsection (2) of 6
this section at least 60 days before the effective date of the 7
modification on its website and in any newsletters.8
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p. 3 HB 2683