Section 182-502-0230 - Provider overpayment disputes-General(1) This section applies to provider overpayment disputes with providers who furnish health care services to Washington apple health clients, except those overpayment disputes to which chapter 182-502A WAC applies. For the purposes of this section: (a) "Agency" means the health care authority and its designees.(b) "Provider" has the same meaning as vendor in RCW 41.05A.010(5).(2) If the medicaid agency determines that a provider was overpaid, the agency may take any of the following actions:(a) Review claims, encounters, or payments;(b) Refer the provider to the agency's office of program integrity;(c) Refer the provider to the Washington state medicaid fraud control unit;(d) Refer the provider to the appropriate state health care professional discipline authority;(e) Terminate the provider's participation in Washington apple health;(f) Assess a civil penalty against the provider, per RCW 74.09.210; (g) In the event of a prepay review, suspend some or all payments;(h) Adjust or void an improper claim, encounter, or payment;(i) Recover any moneys that the provider received as a result of overpayments as authorized under chapter 41.05A RCW; and(j) Any other action authorized by Title 182 WAC.(3) A provider may contest an overpayment by requesting a hearing .(4) The hearing request must: (b) Identify each overpayment being contested;(c) State each reason why the provider thinks the overpayment is incorrect;(d) Include documentation to support the provider's position; and(e) Include a copy of the overpayment notice.(5) The hearing request must be served on the agency at the address specified in the overpayment notice, in a manner which provides proof of receipt, no later than twenty-eight calendar days after the provider received the overpayment notice.(6) The hearing is conducted under the Administrative Procedure Act and chapter 182-526 WAC.Wash. Admin. Code § 182-502-0230
Amended by WSR 15-01-056, Filed 12/10/2014, effective 1/10/201511-14-075, recodified as §182-502-0230, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.080, and 74.09.290. 11-11-017, § 388-502-0230, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.520, 34.05.020, 34.05.220. 00-22-017, § 388-502-0230, filed 10/20/00, effective 11/20/00. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-502-0230, filed 5/3/94, effective 6/3/94. Formerly WAC 388-81-042.