| Momentum Bucket | Early Stage |
| Legal Title | AN ACT Relating to promoting transparency and efficiency in health carrier relations with health care providers and facilities; |
| Bill Description | Promoting transparency and efficiency in health carrier relations with health care providers and facilities. |
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What this bill does
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The bill amends RCW 48.43.750 and adds a new section to chapter 48.43 RCW to change how health carriers handle provider credentialing and to require carriers to post comprehensive billing and coverage information for providers. It requires carriers to use the database selected under RCW 48.165.035 to accept and manage credentialing applications and prohibits carriers from requiring credentialing information in any other format.
The bill changes credentialing timelines and related procedures: it reiterates an existing June 1, 2020 requirement that carriers approve or deny a complete credentialing application within 90 days and adds a requirement that determinations average no more than 60 days (the bill text does not specify the averaging period or methodology). Effective January 1, 2027 carriers must approve or deny a complete application within 30 days. The timing requirements do not obligate carriers to approve applications or place providers into a network and do not apply to health care entities that use credentialing delegation arrangements. The bill defines "credentialing" as the collection, verification, and assessment of whether a provider meets relevant licensing, education, and training requirements.
The bill creates a new procedural requirement that carriers provide access to all billing and health plan coverage information to all health care providers and entities, including nonparticipating providers and facilities. Required information must be available through a centralized, publicly accessible location on the carrier’s website without requiring login, must include coverage, claims, and billing documents needed to determine coverage and reimbursement (examples listed include billing guides, payment policies, prior authorization requirements, clinical review criteria, and claims processing rules), must be compiled in a user-friendly way, and must note any modifications at least 60 days before the modification’s effective date on the website and in any newsletters.
The affected parties identified are health carriers, health care providers (including nonparticipating providers), and health care facilities and entities; entities using credentialing delegation arrangements are explicitly excepted from the credentialing timing subsection. Important context is missing from the extracted text: the specific database selected under RCW 48.165.035 is not identified, key terms such as "health carrier" and "health care entity" are not defined here, the averaging requirement lacks a measurement period or enforcement details, a referenced subsection mentioning the office of the insurance commissioner appears deleted and its implications are unclear, and the text does not include enforcement mechanisms, penalties, or administrative procedures for noncompliance.
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Why it matters
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If enacted, health insurers would be required to accept and manage all provider credentialing through the state-selected database, stop asking for credentialing in any other format, and meet faster decision timelines: current statutory limits remain (90 days and an average of no more than 60 days), with a new deadline of 30 days to approve or deny a complete application starting January 1, 2027 (except for entities that use delegated credentialing). Insurers also must publish, in a single public place on their website without requiring login, all coverage, claims, and billing documents providers need to determine coverage and reimbursement, and give at least 60 days’ notice before changing those documents.
The groups most affected are health carriers, who will likely need to change intake and processing procedures, centralize and maintain public guidance, and potentially shift staffing or workflows to meet faster credentialing deadlines; health care providers and facilities (including nonparticipating providers), who should have quicker credentialing responses and easier access to billing and coverage rules; and entities using delegation arrangements, which are excluded from the 30‑day timing. Important details are missing that affect how these changes play out: the bill references a specific database selection but does not identify which system or how it will operate, it does not define measurement or enforcement of the “average no more than 60 days” requirement, and there is no clear enforcement or penalty language shown here.
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| Official Documents | View Full Bill Text |
| Representative Rule (Primary) |
| Hearing | House Health Care & Wellness (Public) |