HB 2683

H-3192.1
  HOUSE BILL 2683
State of Washington  69th Legislature     2026 Regular Session
By Representative Rule
Read first time 01/27/26.     Referred to Committee on Health Care &
Wellness.
1AN ACT Relating to promoting transparency and efficiency in
2  health carrier relations with health care providers and facilities;
3  amending RCW 48.43.750; and adding a new section to chapter 48.43
4  RCW.
5  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
6     Sec. 1. RCW 48.43.750 and 2020 c 4 s 1 are each amended to read
7 as follows:
8     (1)(a) A health carrier must use the database selected pursuant
9 to RCW 48.165.035 to accept and manage credentialing applications
10 from health care providers. A health carrier may not require a health
11 care provider to submit credentialing information in any format other
12 than through the database selected pursuant to RCW 48.165.035.
13     (b) ((Effective June 1, 2018, a health carrier shall make a
14 determination approving or denying a credentialing application
15 submitted to the carrier no later than ninety days after receiving a
16 complete application from a health care provider.
17     (c))) Effective June 1, 2020, a health carrier shall make a
18 determination approving or denying a credentialing application
19 submitted to the carrier no later than ((ninety)) 90 days after
20 receiving a complete application from a health care provider. All
21 determinations made by a health carrier in approving or denying
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1 credentialing applications must average no more than ((sixty)) 60
2 days.
3     (c) Effective January 1, 2027, a health carrier shall make a
4 determination approving or denying a credentialing application
5 submitted to the carrier no later than 30 days after receiving a
6 complete application from a health care provider.
7     (d) This section does not require health carriers to approve a
8 credentialing application or to place providers into a network.
9     (2) This section does not apply to health care entities that
10 utilize credentialing delegation arrangements in the credentialing of
11 their health care providers with health carriers.
12     (3) For purposes of this section, "credentialing" means the
13 collection, verification, and assessment of whether a health care
14 provider   meets   relevant   licensing,   education,   and   training
15 requirements.
16     (((4) Nothing in this section creates an oversight or enforcement
17 duty on behalf of the office of the insurance commissioner against a
18 health carrier for failure to comply with the terms of this
19 section.))
20     NEW SECTION.   Sec. 2.   A new section is added to chapter 48.43
21 RCW to read as follows:
22     (1) A health carrier shall provide access to all billing and
23 health plan coverage information to all health care providers and
24 entities, including nonparticipating providers and facilities, in
25 order to allow all providers and entities to obtain timely
26 information on patient eligibility and required information and
27 processes to submit claims for reimbursement. Access to this
28 information must be provided through a centralized location available
29 on the health carrier's website or a website operated by the carrier
30 that is available without requiring login.
31     (2)(a) All coverage, claims, and billing documents necessary for
32 a provider or facility to determine coverage of services for an
33 enrollee, required approval or documentation for a claim, or other
34 information necessary to obtain reimbursement for a provided service
35 must be posted as required in subsection (1) of this section. This
36 includes all billing guides, payment policies, billing procedures and
37 standards, administrative rules, medical necessity guidelines, prior
38 authorization requirements, clinical review criteria, retrospective
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1 review   processes,   claims   processing    and   claims   submission
2 requirements, and similar policies, guidelines, and standards.
3     (b) Carriers shall compile the documents required under this
4 subsection in a user-friendly manner.
5     (3) Health carriers shall consciously note any modifications to
6 any of the documents required to be posted under subsection (2) of
7 this section at least 60 days before the effective date of the
8 modification on its website and in any newsletters.
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