The bill adds a new section to chapter 48.43 RCW that creates specific timelines and notice rules for health carrier payment or denial of provider and facility claims, defines “clean claim” and “remittance advice,” and requires carriers to confirm receipt of claims. For clean claims carriers must pay or deny within 30 calendar days; for nonclean claims carriers must acknowledge receipt within 21 days and either deny or request all specific additional information in a single good-faith request. If the carrier requests information, the provider has timelines to respond and the claim becomes a clean claim once the information is received; interest on late payments accrues from the date of failure at 1% per month for days 1–60 and 1.5% per month from day 61 until resolution, interest cannot be applied to a covered person’s cost-sharing, carriers must add interest to the unpaid claim without requiring a separate interest claim, and the insurance commissioner may adopt rules and impose administrative penalties for unresolved violations over 90 days (with specified exemptions and a carrier responsibility rule that carriers remain liable for acts of third parties acting on their behalf). The new section applies to health plans filed or renewed on or after January 1, 2027, covers carriers regulated by the commissioner, participating providers and Indian health care providers (including noncontracting Indian providers as defined in RCW 43.71B.010), and excludes Medicaid managed care plans under chapter 74.09 RCW. The bill reenacts and amends RCW 41.05.017 to make public-employee health plans subject to a list of specified RCW sections that includes the new section added to chapter 48.43 RCW. It also amends RCW 48.43.600 to shorten and specify time limits and procedures for carrier requests for refunds from providers: generally a carrier must make a written refund request within 12 months after the original payment (replacing a longer prior period), for mental health and substance use disorder services the period is six months, and in coordination-of-benefits situations the limit is 18 months (nine months for mental health/substance use disorder). Refund requests must state why the refund is owed, a contested refund may not be required to be paid sooner than six months after the request, and if a provider does not contest a written refund request within 30 days it is deemed accepted. The act also specifies that a carrier may request a refund when a third party (including a government entity) is legally responsible for a claim and the carrier cannot recover from that third party because the third party has already paid or will pay the provider; such refund requests must include the name and mailing address of the entity primarily responsible. The provision overrides conflicting contracts, allows providers to voluntarily refund at any time, and excludes dental-only carriers, Medicare Title XVIII claims, and Medicare supplemental plans under chapter 48.66 RCW. Section 4 of the act is stated to take effect January 1, 2028. The provided excerpts are incomplete: parts of the amendment to RCW 48.43.600 end mid-sentence, the full text and RCW citation for Section 4 are not included here, and the act’s complete effective date language and any additional provisions in the omitted portion are not available in these extracts.

If enacted, health insurers will have to act much faster on provider claims: clean claims must be paid or denied within 30 days and carriers must acknowledge non‑clean claims within 21 days, request all missing information in one good‑faith request, and then pay or deny within 30 days after getting the information. Carriers who miss those deadlines will owe interest that increases after 60 days and could face administrative penalties for patterns of delay beyond 90 days; carriers also remain financially responsible for failures by any third parties or vendors acting for them. This will likely speed cash flow to providers (including Indian health care providers and public employee plans), increase carriers’ short‑term cash outlays and compliance costs, and raise carrier risk exposure if their vendors or systems cause delays. Refund rules change in ways that favor faster recovery by carriers but tighten providers’ timelines: most refund requests must be made within 12 months of the original payment (six months for mental‑health/substance‑use services, shorter windows for coordination‑of‑benefits), and a provider has 30 days to contest or the refund is deemed accepted; carriers must state the third party responsible and, in certain cases, may only seek refunds when a third party has paid the provider. Dental‑only plans, Medicare, and Medicare supplement plans are excluded from the refund section; Medicaid managed care plans are excluded from the timely‑payment rules. Some implementation details and the remaining related text are missing from the provided material, but the act notes applicability to plans filed or renewed on or after January 1, 2027 and that a specified refund provision takes effect January 1, 2028.