The bill amends RCW 48.43.600 to modernize the requirements for health care providers regarding overpayment recovery by carriers. Key changes include reducing the time frame for carriers to request refunds from providers from twenty-four months to twelve months for general claims, and from thirty months to eighteen months for claims related to coordination of benefits. Additionally, the time frame for mental health and substance use disorder services has been adjusted from six 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 specifies that carriers may request refunds at any time if a third party is found liable for the claim, and it establishes that this section takes precedence over conflicting contract terms between carriers and providers. It also defines "refund" and clarifies that the section does not apply to dental-only health carriers or Medicare-related services. The new provisions will take effect on January 1, 2027.

Statutes affected:
Original bill: 48.43.600
Substitute bill: 48.43.600