WAC 296-20-02010   Review of health services providers.  (1) The department may review providers' patient and billing related records to ensure workers are receiving proper and necessary medical care and to ensure providers' compliance with the department's medical aid rules, fee schedules, and policies. A records review may be the basis for corrective action against the provider.

     (2) The department may review records before, during, or after delivery of health services. Records reviews may be for cause or at random and may include the utilization of statistical sampling methodologies and projections based upon sample findings. Records reviews may be conducted at or away from the provider's places of business, at the department's discretion.

     (3) The department will give ten working days' written notification to any provider that the provider's patient and billing related records will be reviewed by an auditor at the provider's place(s) of business to determine compliance with medical aid rules and standards.

     (4) The department may request legible copies of providers' records. Providers shall furnish copies of the requested records within thirty calendar days of receipt of the request.

     (5) The department will not remove original records from provider's premises.

     (6) For information regarding the formal appeals process refer to chapter 51.52 RCW.



[Statutory Authority: RCW 51.04.020. 03-21-069, § 296-20-02010, filed 10/14/03, effective 12/1/03. Statutory Authority: RCW 51.04.020(4) and 51.04.030. 90-04-057, § 296-20-02010, filed 2/2/90, effective 3/5/90; 86-20-074 (Order 86-36), § 296-20-02010, filed 10/1/86, effective 11/1/86.]