Health carrier payments

AN ACT Relating to modernizing and clarifying timely payment 1
requirements for health carriers; reenacting and amending RCW 2
41.05.017; adding a new section to chapter 48.43 RCW; and creating a 3
new section. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. (1) The legislature finds that timeliness 6
of payment and administrative burden related to obtaining payment 7
from health carriers are contributing factors to the financial 8
vulnerability for health care providers and health care facilities 9
and impact availability of care and delay the determination of cost 10
sharing for patients.11
(2) It is the intent of the legislature to increase transparency 12
and accountability for claims payment timeliness by updating payment 13
standards to better reflect claims operations and provide an 14
objective and quantifiable standard. 15
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 16
RCW to read as follows: 17
(1)(a) Except as provided in (b) of this subsection, for health 18
care services provided to covered persons, a carrier shall pay or 19
S-3476.2
SENATE BILL 5845
State of Washington 69th Legislature 2026 Regular Session
By Senators Slatter, Muzzall, Chapman, Harris, Riccelli, Cleveland,
Hasegawa, Krishnadasan, Nobles, and Valdez
Prefiled 12/08/25. Read first time 01/12/26. Referred to Committee
on Health & Long-Term Care.
p. 1 SB 5845
deny a claim from a provider or facility as soon as practical, but no 1
later than 30 days after the receipt of a clean claim by the carrier.2
(b) For claims that are not clean, within 14 days of receipt of 3
the claim, the carrier shall send a written notice to the provider or 4
facility acknowledging the date of receipt of the claim and one of 5
the following: 6
(i) That the carrier is denying payment on all or part of the 7
claim and the specific reason for the denial. The denial shall 8
identify the portion of the claim that is denied and the specific 9
reasons for the denial; or 10
(ii) That additional information or documentation is needed to 11
process the claim. This notice must include a request for the 12
specific information or documentation needed to process the claim. 13
The carrier shall make a good faith effort to request all information 14
or documentation needed to process the claim in a single request.15
(c) Following receipt of all information or documentation 16
requested by the carrier in a notice issued pursuant to (b)(ii) of 17
this subsection, the carrier shall consider the claim a clean claim 18
and shall pay or deny the claim within 30 days, except as agreed to 19
in writing by the parties on a claim-by-claim basis.20
(d) The receipt date of a claim or additional information or 21
documentation is the date a carrier receives either written or 22
electronic notice of the claim or additional information or 23
documentation. A carrier must establish a reasonable method for 24
confirming receipt of claims and additional information or 25
documentation and responding to provider and facility inquiries about 26
claims. 27
(2)(a) A carrier shall pay interest on the amount of any claims 28
for which the carrier fails to comply with the timeline and notice 29
requirements of subsection (1) of this section. Interest shall accrue 30
on each such claim until the claim is resolved by payment, denial, or 31
the final outcome of an appeals process. 32
(b) Interest shall be assessed at the following rates and shall 33
be calculated monthly as simple interest prorated for any portion of 34
a month: 35
(i) Beginning on day one and through day 60 following a carrier's 36
failure to comply with any notice or claim settlement requirement in 37
subsection (1)(a) or (b) of this section, interest shall be assessed 38
at the rate of one percent per month on the amount of the unresolved 39
claim. 40
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(ii) Beginning on day 61 following a carrier's failure to comply 1
with any notice or claim settlement requirement in subsection (1)(a) 2
or (b) of this section and until the claim is resolved, interest 3
shall be assessed at the rate of one and one-half percent per month 4
on the amount of the unresolved claim. 5
(c) Any interest paid under this subsection shall be the 6
carrier's responsibility and not be applied by the carrier to a 7
covered person's deductible, copayment, coinsurance, or any similar 8
obligation of the covered person. 9
(d) The carrier shall add the interest payable to the amount of 10
the unpaid claim and may not require or request the provider or 11
facility to submit an additional claim. 12
(e) For any claim for which the carrier failed to comply with the 13
requirements of subsection (1)(a) or (b) of this section that is 14
unresolved for more than 90 days, the carrier shall be subject to an 15
administrative penalty as determined by the commissioner in rule.16
(3) The requirements of this section do not apply to claims about 17
which there is substantial evidence of fraud or misrepresentation by 18
providers, facilities, or covered persons. 19
(4) Providers, facilities, and carriers are not required to 20
comply with the requirements of this section if the failure to comply 21
is occasioned by any act of God, bankruptcy, act of a governmental 22
authority responding to an act of God or other emergency, or the 23
result of a strike, lockout, or other labor dispute.24
(5) Health carriers are responsible for compliance with the 25
provisions of this chapter and are responsible for the compliance of 26
any person or organization acting on behalf of or at the direction of 27
the carrier or acting pursuant to carrier standards or requirements 28
concerning the coverage of, payment for, or provision of health care 29
services. A carrier may not offer as a defense to a violation of any 30
provision of this chapter that the violation arose from the act or 31
omission of a participating provider or facility, network 32
administrator, claims administrator, health care benefit manager, or 33
other person acting on behalf of or at the direction of the carrier, 34
or acting pursuant to carrier standards or requirements under a 35
contract with the carrier rather than from the direct act or omission 36
of the carrier. 37
(6) Nothing in this section limits any existing authority of the 38
office of the insurance commissioner under this title to oversee and 39
enforce carrier compliance with applicable statutes and rules.40
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(7) The requirements of this section apply to plans filed or 1
renewed on or after January 1, 2027. 2
(8) The commissioner may adopt rules to implement this section.3
(9) For purposes of this section, "clean claim" means a claim 4
that has no defect or impropriety, including any lack of any required 5
substantiating documentation, or particular circumstances requiring 6
special treatment that prevents timely payments from being made on 7
the claim. A claim does not lose the status of "clean claim" due to 8
issues related to carrier internal processing or systems.9
Sec. 3. RCW 41.05.017 and 2025 c 389 s 3 and 2025 c 171 s 2 are 10
each reenacted and amended to read as follows: 11
Each health plan that provides medical insurance offered under 12
this chapter, including plans created by insuring entities, plans not 13
subject to the provisions of Title 48 RCW, and plans created under 14
RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 15
70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 16
48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 17
48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 18
48.200.300 through 48.200.320, 48.43.440, 48.43.845, 48.43.732, 19
section 2 of this act, and chapter 48.49 RCW. 20
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