Wash. Admin. Code § 296-19A-370 - What are the procedures for adjustments to provider bills?

Current through Register Vol. 21-18, September 15, 2021

(1) The department or self-insurer may adjust payment of charges when appropriate. The department or self-insurer must provide a written explanation of why they adjusted a billing or line item of a bill when they make any adjustment. In cases where the department is the referral source, it will not give the provider a written explanation if the department made the adjustment solely to conform to its maximum allowable fees.
(2) The department or self-insurer must receive any inquiries about a bill adjustment within ninety days from the date of payment to be considered. All provider inquiries must be in the required format.

Notes

Wash. Admin. Code § 296-19A-370

Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. 00-18-078, § 296-19A-370, filed 9/1/00, effective 6/1/01.

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