SB 5845 — Modernizing and clarifying timely payment requirements for health carriers.

ENGROSSEDS-3476.2 SUBSTITUTE SENATE BILL 5845 State of Washington 69th Legislature 2026 Regular Session By Senate Health & Long-Term Care (originally sponsored by Senators Slatter, Muzzall, Chapman, Harris, Riccelli, Cleveland, Hasegawa, Krishnadasan, Nobles, and Valdez)Valdez READPrefiled FIRST12/08/25. TIME 02/02/26.

Read first time 01/12/26.

Referred to Committee on Health & Long-Term Care.

(1)(a) Except as provided in (b) of this subsection, for health care services provided to covered persons, a carrier shall pay or deny a claim from a provider or facility as soon as practical, but no p.

1 ESSBSB 5845 deny a claim from a provider or facility as soon as practical, but no later than 30 calendar days after the receipt of a clean claim by the carrier.

(b) For claims that are not clean, within 2114 calendar days of receipt of the claim, the carrier shall send remittancea advicewritten or other electronic notice to the provider or facility acknowledging the date of receipt of the claim and including one of the following:

The carrier shall make a good faith effort to request all information or documentation needed to process the claim in a single requestrequest. and may not make any additional requests for information or documentation for 30 calendar days after receipt of the claim.

(c)(i)(c) ForFollowing claimsreceipt forof which the carrier receives all information or documentation requested by the carrier in a notice issued pursuant to (b)(ii) of this subsection, the carrier shall consider the claim a clean claim and shall pay or deny the claim within 30 calendar days, except as agreed to in writing by the parties on a claim-by-claim basis.

The 30 calendar days time period does not apply until the carrier receives all information or documentation requested by the carrier.

(ii) For claims for which a provider or facility fails to submit information or documentation requested under subsection (1)(b)(ii) of this section within 21 calendar days of receipt of the carrier's request, the carrier's obligation to pay or deny the claim under this subsection is extended to 40 calendar days following the carrier's receipt of requested information or documentation.

(2)(a) A carrier shall pay interest on the amount of any claims for which the carrier fails to comply with the timeline and notice p.requirements of subsection (1) of this section.

2 ESSB 5845 requirements of subsection (1) of this section.

(i) Beginning on calendar day one and through calendar day 60 following a carrier's failure to comply with any notice or claim settlement requirement in subsection (1)(a) or (b) of this section, interest shall be assessed at the rate of one percent per month on the amount of the unresolved claim.

(ii)p. Beginning on calendar day 61 following a carrier's failure to comply with any notice or claim settlement requirement in subsection (1)(a) or (b) of this section and until the claim is resolved, interest shall be assessed at the rate of one and one-half percent per month on the amount of the unresolved claim.

2 SB 5845 (ii) Beginning on day 61 following a carrier's failure to comply with any notice or claim settlement requirement in subsection (1)(a) or (b) of this section and until the claim is resolved, interest shall be assessed at the rate of one and one-half percent per month on the amount of the unresolved claim.

(e) For any claim for which the carrier failed to comply with the requirements of subsection (1)(a) or (b) of this section that is unresolved for more than 90 calendar days, the carrier mayshall be subject to an administrative penalty as determined by the commissioner in rule.

In(3) developingThe therequirements appropriateness of anthis administrativesection penalty,do thenot commissionerapply shallto considerclaims whetherabout awhich carrierthere hasis engagedsubstantial inevidence aof patternfraud ofor violationsmisrepresentation ofby subsectionproviders, (1)(a)facilities, or (b)covered ofpersons. this section.

(3)(4) TheProviders, facilities, and carriers are not required to comply with the requirements of this section doif notthe applyfailure to claimscomply foris whichoccasioned aby carrierany hasact documentedof evidenceGod, bankruptcy, act of frauda orgovernmental materialauthority misrepresentationresponding byto providers,an facilities,act orof coveredGod persons,or supportedother byemergency, claimsor review,the dataresult analysis,of audita activities,strike, lockout, or patternsother thereof.labor dispute.

(4) Providers, facilities, and carriers are not required to comply with the requirements of this section if the failure to comply is occasioned by any act of God, bankruptcy, act of a governmental authority responding to an act of God or other emergency, p.

3 ESSB 5845 cybersecurity attack, declaration of a natural disaster, or the result of a strike, lockout, or other labor dispute.

(7)(a)p. The requirements of this section apply to health plans filed or renewed on or after January 1, 2027.

(b)3 ThisSB section5845 applies(7) onlyThe torequirements healthof carriersthis offeringsection healthapply plans subject to regulation by the commissioner and to health plans offeredfiled throughor therenewed publicon employees'or benefitsafter boardJanuary and1, school2027. employees' benefits board programs.

This section does not apply to medicaid managed care plans administered under chapter 74.09 RCW.

(c) This section applies only to claims submitted by a health care provider or health care facility that is a participating provider or facility under a contract with a health carrier.

Nothing in this section is intended to modify or supersede payment requirements applicable to nonparticipating providers or facilities, including those governed by RCW 48.49.160.

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

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

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4 ESSB 5845 (b) "Remittance advice" means a written or electronic communication issued by a carrier to a provider that explains the outcome of claim adjudication and includes, at a minimum, the amount paid, any amounts denied or adjusted, and the reason codes and explanations supporting the carrier's payment determination.

54 ESSBSB 5845