Wash. Admin. Code § 182-70-050 - Data submission schedule
(1) Data suppliers shall submit the required
health care data in accordance with the schedule provided in this
section.
(2)
Test
file.
(a) At least sixty calendar days
prior to the data suppliers' first required submission, the lead organization
will notify the data supplier in writing regarding the obligation to file. The
lead organization will schedule time to work with the data supplier to
establish a schedule for when the data supplier shall submit the initial test
files.
(b) No more than ninety
calendar days after notification of changes in requirements in the data
submission guide, the data supplier shall submit initial test files. This
deadline may be extended by the lead organization when it determines that
additional time will be needed in order for the change to be
implemented.
(3)
Submission file. Data and claim files shall be submitted to the
WA-APCD on a quarterly basis. On or before April 30th, July 31st, October 31st
and January 31st of each year, data and claim files shall be submitted for all
nondenied adjudicated claims paid in the preceding three months.
(4)
Resubmission file. Failure
to conform to the requirements of this chapter or the data submission guide
shall result in the rejection of the applicable data and claim files. The lead
organization shall notify the data supplier when data and claim files are
rejected. All rejected files must be resubmitted in the appropriate, corrected
format within fifteen business days of notification unless a written request
for an extension is received by the lead organization before the expiration of
this fifteen business day period.
(5)
Claims run-out file. If
health care coverage is terminated for a Washington covered person, the data
supplier shall submit data for a six month period following the health care
coverage termination date.
(6)
Replacement file.
(a) A data
supplier may replace a complete data file, claim file or both data and claim
file submission. Requests must be made to the lead organization with a detailed
explanation as to why the replacement is needed. The lead organization shall
make a recommendation to the authority as to whether to approve or deny the
request. The approval recommendation shall also state whether the approval is
for the entire period requested or for a period less than requested.
(b) The authority shall approve or deny the
request and provide written notification to the requestor within thirty
calendar days of receipt of the request. The authority decision on the request
for a replacement file will be provided in writing. If the authority does not
approve the complete request for a replacement file, the written notification
will include the reason for the denial or approval of the shorter period of
time.
(c) Requests may not be made
more than one year after the end of the month in which the file was submitted
unless the data supplier can establish exceptional circumstances for the
replacement. The lead organization may recommend approval and the authority may
approve a request for more than one year for exceptional circumstances. The
authority shall approve or deny the request using the process set forth in (b)
of this subsection.
Notes
Statutory Authority: Chapter 43.371 RCW. WSR 16-04-068, § 82-75-050, filed 1/29/16, effective 2/29/16.
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