Health carrier payment times

AN ACT Relating to health carrier transparency of payment 1
timeliness of claims submitted by health care providers and health 2
care facilities; adding a new section to chapter 48.43 RCW; adding a 3
new section to chapter 74.09 RCW; adding a new section to chapter 4
41.05 RCW; and creating a new section. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. (1) The legislature finds that timeliness 7
of payment and administrative burden related to obtaining payment 8
from health insurance carriers, health plans, and managed care 9
organizations are contributing factors to the financial vulnerability 10
for health care providers and health care facilities, and the care 11
available for patients is negatively impacted due to delays in 12
payment.13
(2) It is the intent of the legislature to increase transparency 14
regarding timeliness of claims payment by health insurance carriers, 15
health plans, and managed care organizations by requiring carriers to 16
report to the office of the insurance commissioner and the health 17
care authority metrics related to timeliness of payment and for the 18
office of the insurance commissioner and the health care authority to 19
report the information in a public manner. 20
S-1201.1
SENATE BILL 5683
State of Washington 69th Legislature 2025 Regular Session
By Senators Slatter, Frame, Nobles, and Valdez
Read first time 02/06/25. Referred to Committee on Health & Long-
Term Care.
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NEW SECTION. Sec. 2. A new section is added to chapter 48.43 1
RCW to read as follows: 2
(1) By January 1, 2027, and annually thereafter, each carrier 3
shall report to the commissioner the following data related to the 4
carrier's claims payment timeliness for the prior plan year:5
(a) The total number of claims submitted for items and services 6
furnished to individuals enrolled in plans administered by the 7
carrier by providers of services and suppliers with which the carrier 8
has a contract with respect to furnishing such items and services;9
(b) The total number of claims described in (a) of this 10
subsection that were determined to be clean claims and the total 11
number of claims that were determined not to be clean claims;12
(c) The total number of claims described in (a) of this 13
subsection for which itemized billing or additional information is 14
requested by the carrier; 15
(d) The average days, and total range of days, between the date 16
on which providers of services and suppliers submitted additional 17
information or documents requested by the carrier for purposes of 18
processing and paying claims described in (c) of this subsection and 19
the date on which the carrier notified the providers of services and 20
suppliers of the carrier's determination for such claims;21
(e) The average days, and total range of days, between the date 22
of submission of claims described in (a) of this subsection 23
determined to be clean claims and the date on which the provider of 24
services or supplier received from the carrier full payment of such 25
claims; 26
(f) The average days, and total range of days, between the date 27
of submission of claims described in (a) of this subsection 28
determined to not be clean claims and the date on which the provider 29
of services or supplier received from the carrier full payment of 30
such claims; 31
(g) The percentage of all claims described in (a) of this 32
subsection, if any, fully paid by the carrier within 30 days of the 33
date of submission of the claim; and 34
(h) Such other information as specified by the commissioner.35
(2) For purposes of this section, "clean claim" means a claim 36
that has no defect or impropriety, including a lack of any required 37
substantiating documentation or particular circumstances requiring 38
special treatment that prevents timely payments from being made on 39
the claim. 40
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(3) By July 1, 2027, and annually thereafter, the commissioner 1
shall submit to the relevant committees of the legislature and 2
publish on a public website a report including: 3
(a) The detailed information submitted by each carrier under 4
subsection (1) of this section, including the identity of the carrier 5
submitting the information; 6
(b) A summary of the information submitted for such year by all 7
carriers under subsection (1) of this section; 8
(c) A summary of the complaints received by the commissioner 9
relating to timely payment of claims submitted during such year, by 10
the carrier; and 11
(d) An analysis on the carrier level and statewide level of 12
trends shown by such information submitted under this section.13
NEW SECTION. Sec. 3. A new section is added to chapter 74.09 14
RCW to read as follows: 15
(1) By January 1, 2027, and annually thereafter, each managed 16
care organization shall report to the authority the following data 17
related to the managed care organization's claims payment timeliness 18
for the prior plan year: 19
(a) The total number of claims submitted for items and services 20
furnished to the managed care organization's enrollees by 21
participating providers and facilities; 22
(b) The total number of claims described in (a) of this 23
subsection that were determined to be clean claims and the total 24
number of claims that were determined not to be clean claims;25
(c) The total number of claims described in (a) of this 26
subsection for which itemized billing or additional information is 27
requested by the managed care organization; 28
(d) The average days, and total range of days, between the date 29
on which providers of services and suppliers submitted additional 30
information or documents requested by the managed care organization 31
for purposes of processing and paying claims described in (c) of this 32
subsection and the date on which the managed care organization 33
notified the providers of services and suppliers of the managed care 34
organization's determination for such claims; 35
(e) The average days, and total range of days, between the date 36
of submission of claims described in (a) of this subsection 37
determined to be clean claims and the date on which the provider of 38
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services or supplier received from the managed care organization full 1
payment of such claims; 2
(f) The average days, and total range of days, between the date 3
of submission of claims described in (a) of this subsection 4
determined to not be clean claims and the date on which the provider 5
of services or supplier received from the managed care organization 6
full payment of such claims; 7
(g) The percentage of all claims described in (a) of this 8
subsection, if any, fully paid by the managed care organization 9
within 30 days of the date of submission of the claim; and10
(h) Such other information as specified by the authority.11
(2) For purposes of this section, "clean claim" means a claim 12
that has no defect or impropriety, including a lack of any required 13
substantiating documentation or particular circumstances requiring 14
special treatment that prevents timely payments from being made on 15
the claim. 16
(3) By July 1, 2027, and annually thereafter, the authority shall 17
submit to the relevant committees of the legislature and publish on a 18
public website a report including: 19
(a) The detailed information submitted by each managed care 20
organization under subsection (1) of this section, including the 21
identity of the managed care organization submitting the information;22
(b) A summary of the information submitted for such year by all 23
managed care organizations under subsection (1) of this section;24
(c) A summary of the complaints received by the authority 25
relating to timely payment of claims submitted during such year, by 26
the managed care organization; and 27
(d) An analysis on the managed care organization level and 28
statewide level of trends shown by such information submitted under 29
this section. 30
NEW SECTION. Sec. 4. A new section is added to chapter 41.05 31
RCW to read as follows: 32
(1) By January 1, 2027, and annually thereafter, each health plan 33
offered to public employees, retirees, and their covered dependents 34
under this chapter shall report to the authority the following data 35
related to the health plan's claims payment timeliness for the prior 36
plan year: 37
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(a) The total number of claims submitted for items and services 1
furnished to the health plan's enrollees by participating providers 2
and facilities; 3
(b) The total number of claims described in (a) of this 4
subsection that were determined to be clean claims and the total 5
number of claims that were determined not to be clean claims;6
(c) The total number of claims described in (a) of this 7
subsection for which itemized billing or additional information is 8
requested by the health plan; 9
(d) The average days, and total range of days, between the date 10
on which providers of services and suppliers submitted additional 11
information or documents requested by the health plan for purposes of 12
processing and paying claims described in (c) of this subsection and 13
the date on which the health plan notified the providers of services 14
and suppliers of the health plan's determination for such claims;15
(e) The average days, and total range of days, between the date 16
of submission of claims described in (a) of this subsection 17
determined to be clean claims and the date on which the provider of 18
services or supplier received from the health plan full payment of 19
such claims; 20
(f) The average days, and total range of days, between the date 21
of submission of claims described in (a) of this subsection 22
determined to not be clean claims and the date on which the provider 23
of services or supplier received from the health plan full payment of 24
such claims; 25
(g) The percentage of all claims described in (a) of this 26
subsection, if any, fully paid by the health plan within 30 days of 27
the date of submission of the claim; and 28
(h) Such other information as specified by the authority.29
(2) For purposes of this section, "clean claim" means a claim 30
that has no defect or impropriety, including a lack of any required 31
substantiating documentation, or particular circumstances requiring 32
special treatment that prevents timely payments from being made on 33
the claim. 34
(3) By July 1, 2027, and annually thereafter, the authority shall 35
submit to the relevant committees of the legislature and publish on a 36
public website a report including: 37
(a) The detailed information submitted by each health plan under 38
subsection (1) of this section, including the identity of the health 39
plan submitting the information; 40
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(b) A summary of the information submitted for such year by all 1
health plans under subsection (1) of this section; 2
(c) A summary of the complaints received by the authority 3
relating to timely payment of claims submitted during such year, by 4
the health plan; and 5
(d) An analysis on the health plan level and statewide level of 6
trends shown by such information submitted under this section.7
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