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PDFWAC 182-526-0205

Appeals requested by a data supplier to the Washington all payer health care claims database (WA-APCD).

(1) Appeal. A data supplier may request an appeal of a denial of its administrative review conducted in accordance with WAC 182-70-100.
(a) Request for an appeal must be submitted in writing to the health care authority (HCA) within fifteen calendar days after receipt of written notification of denial of its administrative review.
(b) An appeal request must contain:
(i) The requestor's name;
(ii) The requestor's mailing address;
(iii) The requestor's telephone number;
(iv) A description of HCA's action being contested;
(v) A brief explanation of why the person or entity disagrees with HCA's action; and
(vi) Any accommodation to help the requestor fully participate in the hearing, if applicable.
(c) Within ten business days of receipt of a written notice of appeal, HCA transmits the request to the office of administrative hearings (OAH).
(2) Scheduling.
(a) OAH will assign an administrative law judge (ALJ) to handle the appeal.
(b) The ALJ will notify parties of the time when any additional documents or arguments must be submitted.
(c) If a party fails to comply with a scheduling letter or established timelines, the ALJ may decline to consider arguments or documents submitted after the scheduled timelines.
(d) A status conference in complex cases may be scheduled to provide for the orderly resolution of the case and to narrow issues and arguments for hearing.
(3) Hearings.
(a) The hearing must be conducted in accordance with the Administrative Procedure Act, chapter 34.05 RCW, and this chapter. To the extent that there may be a conflict between the general provisions contained in this chapter and this section, the more specific provisions in this section apply.
(b) Hearings may be by telephone or in person.
(c) The ALJ may decide the case without a hearing if legal or factual issues are not in dispute, the appellant does not request a hearing, or the appellant fails to appear at a scheduled hearing or otherwise fails to respond to inquiries.
(d) The ALJ will notify the appellant by mail whether a hearing will be held, whether the hearing will be in person or by telephone, the location of any in-person hearing, and the date and time for any hearing in the case.
(e) The date and time for a hearing may be continued at the ALJ's discretion.
(f) Other authority employees may attend a hearing, and the ALJ notifies the appellant when other authority employees are attending. The appellant may appear in person or may be represented by an attorney.
[Statutory Authority: RCW 41.05.021, 41.05.160, 43.71C.110, and 2019 c 334. WSR 21-11-039, ยง 182-526-0205, filed 5/12/21, effective 6/12/21.]
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