SB 5683 — Concerning health carrier transparency of payment timeliness of claims submitted by health care providers and health care facilities.

S-1626.1S-1201.1 SUBSTITUTE SENATE BILL 5683 State of Washington 69th Legislature 2025 Regular Session By Senate Health & Long-Term Care (originally sponsored by Senators Slatter, Frame, Nobles, and Valdez)Valdez READRead FIRSTfirst TIMEtime 02/21/25.02/06/25.

Referred to Committee on Health & Long- Term Care.

1 SSBSB 5683 NEW SECTION.

(1) By January 1, 2027, and annually thereafter, each carrier shall report to the commissioner,commissioner in a form and manner determined by the commissioner, the following data related to the carrier's claims payment timeliness for the prior plan year:

and (h) Such other information relating to the carrier's claims payment timeliness as specified by the commissioner.

(2) For purposes of this section, "clean claim" means a claim that has no defect or impropriety, including a lack of any required substantiating documentation or particular circumstances requiring p.special treatment that prevents timely payments from being made on the claim.

2p. SSB 5683 special treatment that prevents timely payments from being made on the claim.

2 SB 5683 (3) By July 1, 2027, and annually thereafter, the commissioner shall submit to the relevant committees of the legislature and publish on a public website a report including:

(c) A summary of the complaints received by the commissioner relating to timely payment of claims submitted during such year, organized by the carriercarrier; at issue in the complaint;

(1) By January 1, 2027, and annually thereafter, each managed care organization shall report to the authority,authority in a form and manner determined by the authority, the following data related to the managed care organization's claims payment timeliness for the prior plan year:

(e) The average days, and total range of days, between the date of submission of claims described in (a) of this subsection determined to be clean claims and the date on which the provider of p.

3 SSBSB 5683 (e) The average days, and total range of days, between the date of submission of claims described in (a) of this subsection determined to be clean claims and the date on which the provider of services or supplier received from the managed care organization full payment of such claims;

and (h) Such other information relating to the managed care organization's claims payment timeliness as specified by the authority.

(c) A summary of the complaints received by the authority relating to timely payment of claims submitted during such year, organized by the managed care organizationorganization; at issue in the complaint;

(1) By January 1, 2027, and annually thereafter, each health plan offered to public employees, retirees, and their covered dependents under this chapter shall report to the authority the following data related to the health plan's claims payment timeliness for the prior plan year:

4 SSBSB 5683 (1)(a) ByThe Januarytotal 1,number 2027,of andclaims annuallysubmitted thereafter,for eachitems health plan offered to public employees, retirees, and theirservices coveredfurnished dependents under this chapter shall report to the authority, in a form and manner determined by the authority, the following data related to the health plan's claimsenrollees paymentby timelinessparticipating forproviders theand priorfacilities; plan year:

(a) The total number of claims submitted for items and services furnished to the health plan's enrollees by participating providers and facilities;

and (h) Such other information relating to the health plan's claims payment timeliness as specified by the authority.

p.(3) By July 1, 2027, and annually thereafter, the authority shall submit to the relevant committees of the legislature and publish on a public website a report including:

5 SSB 5683 (3) By July 1, 2027, and annually thereafter, the authority shall submit to the relevant committees of the legislature and publish on a public website a report including:

(b)p. A summary of the information submitted for such year by all health plans under subsection (1) of this section;

(c)5 SB 5683 (b) A summary of the complaintsinformation received by the authority relating to timely payment of claims submitted duringfor such year,year organized by theall health planplans atunder issuesubsection in(1) theof complaint;this section;

(c) A summary of the complaints received by the authority relating to timely payment of claims submitted during such year, by the health plan;

6 SSBSB 5683