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PDFWAC 296-19A-360

What are the requirements for bills submitted to the department?

(1) Any bill a provider submits to the department must include the following information:
(a) Worker's name;
(b) Worker's claim number;
(c) Vocational referral number;
(d) Dates of service;
(e) Place of service;
(f) Type of service;
(g) Appropriate procedure code(s);
(h) Charge;
(i) Units of service;
(j) Total bill charge;
(k) The name and the department-assigned provider ID of the counselor or intern rendering the services;
(l) Provider number of the payee;
(m) Date of billing;
(n) Submission of any supporting documentation required under other sections of this chapter.
(2) Itemize the bills on department approved forms. A vocational rehabilitation provider may transmit the bills electronically if the provider uses department file format specifications. If the provider uses any of the electronic transfer options, the provider must follow department instructions for electronic billing.
(3) The provider must bill using procedure codes, fees, and methods provided by the department. The department will publish codes, fees, and procedures and provide this information to all vocational rehabilitation providers receiving department referrals. The department will establish fees at regular intervals.
(4) Document all billed charges and justify the type, level and extent of services in the case notes. A provider's billed charges must be consistent with the services provided. The department may reduce, deny, or recoup payment whenever case notes fail to document billed charges or services provided.
(5) It is the vocational rehabilitation provider's responsibility to make sure the charges billed are complete and accurate, even if a third party is actually performing the billing.
(6) The vocational rehabilitation provider is encouraged to bill every two weeks. The department must receive bills within one year of the date of service to be eligible for payment.
[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 00-18-078, ยง 296-19A-360, filed 9/1/00, effective 6/1/01.]
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