Health carrier overpayments

AN ACT Relating to standardizing overpayment recovery 1
requirements; amending RCW 48.43.600; and providing an effective 2
date. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 48.43.600 and 2025 c 227 s 7 are each amended to 5
read as follows: 6
(1) Except in the case of fraud, or as provided in subsections 7
(2) and (3) of this section, a carrier may not: (a) Request a refund 8
from a health care provider of a payment previously made to satisfy a 9
claim unless it does so in writing to the provider ((within twenty-10
four months after the date that the payment was made or, in the case 11
of mental health and substance use disorder services as defined in 12
RCW 48.43.766,)) within six months after the date the payment was 13
made; or (b) request that a contested refund be paid any sooner than 14
six months after receipt of the request. Any such request must 15
specify why the carrier believes the provider owes the refund. If a 16
provider fails to contest the request in writing to the carrier 17
within thirty days of its receipt, the request is deemed accepted and 18
the refund must be paid. 19
(2) A carrier may not, if doing so for reasons related to 20
coordination of benefits with another carrier or entity responsible 21
S-3818.1
SENATE BILL 6071
State of Washington 69th Legislature 2026 Regular Session
By Senators Cleveland, Harris, Nobles, and Trudeau
Read first time 01/13/26. Referred to Committee on Health & Long-
Term Care.
p. 1 SB 6071
for payment of a claim: (a) Request a refund from a health care 1
provider of a payment previously made to satisfy a claim unless it 2
does so in writing to the provider ((within thirty months after the 3
date that the payment was made or, in the case of mental health and 4
substance use disorder services as defined in RCW 48.43.766,)) within 5
nine months after the date the payment was made; or (b) request that 6
a contested refund be paid any sooner than six months after receipt 7
of the request. Any such request must specify why the carrier 8
believes the provider owes the refund, and include the name and 9
mailing address of the entity that has primary responsibility for 10
payment of the claim. If a provider fails to contest the request in 11
writing to the carrier within thirty days of its receipt, the request 12
is deemed accepted and the refund must be paid. 13
(3) A carrier may at any time request a refund from a health care 14
provider of a payment previously made to satisfy a claim if: (a) A 15
third party, including a government entity, is found responsible for 16
satisfaction of the claim as a consequence of liability imposed by 17
law, such as tort liability; and (b) the carrier is unable to recover 18
directly from the third party because the third party has either 19
already paid or will pay the provider for the health services covered 20
by the claim. 21
(4) If a contract between a carrier and a health care provider 22
conflicts with this section, this section shall prevail. However, 23
nothing in this section prohibits a health care provider from 24
choosing at any time to refund to a carrier any payment previously 25
made to satisfy a claim. 26
(5) For purposes of this section, "refund" means the return, 27
either directly or through an offset to a future claim, of some or 28
all of a payment already received by a health care provider.29
(6) This section neither permits nor precludes a carrier from 30
recovering from a subscriber, enrollee, or beneficiary any amounts 31
paid to a health care provider for benefits to which the subscriber, 32
enrollee, or beneficiary was not entitled under the terms and 33
conditions of the health plan, insurance policy, or other benefit 34
agreement. 35
(7) This section does not apply to claims for health care 36
services provided through dental only health carriers, health care 37
services provided under Title XVIII (medicare) of the social security 38
act, or medicare supplemental plans regulated under chapter 48.66 39
RCW. 40
p. 2 SB 6071
NEW SECTION. Sec. 2. Section 1 of this act takes effect January 1
1, 2027.2
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p. 3 SB 6071