The bill amends RCW 48.43.600 to standardize the requirements for health care providers regarding overpayment recovery by carriers. It establishes that, except in cases of fraud, carriers must request refunds in writing within six months of payment, rather than the previous twenty-four months. Additionally, for coordination of benefits with other entities, the timeframe for requesting refunds is adjusted from thirty months to nine months. The bill also clarifies that if a provider does not contest a refund request within thirty days, the request is deemed accepted.

Furthermore, the bill allows carriers to request refunds at any time if a third party is found liable for the claim but does not permit the carrier to recover amounts from subscribers or enrollees for benefits not entitled under their health plans. It specifies that this section does not apply to dental-only health carriers or services provided under Medicare. The new provisions will take effect on January 1, 2027.

Statutes affected:
Original bill: 48.43.600