wa-law.org > bill > 2025-26 > HB 2683 > Original Bill

HB 2683 - Health carriers & providers

Source

Section 1

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    1. A health carrier must use the database selected pursuant to RCW 48.165.035 to accept and manage credentialing applications from health care providers. A health carrier may not require a health care provider to submit credentialing information in any format other than through the database selected pursuant to RCW 48.165.035.

    b.

Effective June 1, 2020, a health carrier shall make a determination approving or denying a credentialing application submitted to the carrier no later than 90 days after receiving a complete application from a health care provider. All determinations made by a health carrier in approving or denying credentialing applications must average no more than 60 days.

c. Effective January 1, 2027, a health carrier shall make a determination approving or denying a credentialing application submitted to the carrier no later than 30 days after receiving a complete application from a health care provider.

d. This section does not require health carriers to approve a credentialing application or to place providers into a network.

  1. This section does not apply to health care entities that utilize credentialing delegation arrangements in the credentialing of their health care providers with health carriers.

  2. For purposes of this section, "credentialing" means the collection, verification, and assessment of whether a health care provider meets relevant licensing, education, and training requirements.

Section 2

  1. A health carrier shall provide access to all billing and health plan coverage information to all health care providers and entities, including nonparticipating providers and facilities, in order to allow all providers and entities to obtain timely information on patient eligibility and required information and processes to submit claims for reimbursement. Access to this information must be provided through a centralized location available on the health carrier's website or a website operated by the carrier that is available without requiring login.

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    1. All coverage, claims, and billing documents necessary for a provider or facility to determine coverage of services for an enrollee, required approval or documentation for a claim, or other information necessary to obtain reimbursement for a provided service must be posted as required in subsection (1) of this section. This includes all billing guides, payment policies, billing procedures and standards, administrative rules, medical necessity guidelines, prior authorization requirements, clinical review criteria, retrospective review processes, claims processing and claims submission requirements, and similar policies, guidelines, and standards.

    2. Carriers shall compile the documents required under this subsection in a user-friendly manner.

  3. Health carriers shall consciously note any modifications to any of the documents required to be posted under subsection (2) of this section at least 60 days before the effective date of the modification on its website and in any newsletters.

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