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PDFWAC 296-31-072

Are provider records subject to a health care services review or an audit?

(1) We may review or audit patient and related billing records to ensure:
(a) Claimants are receiving proper and necessary care; and
(b) You are complying with our mental health rules, fee schedules, and policies.
A records review can become the basis of corrective action against you.
(2) We may review your records:
(a) Before, during or after delivery of services;
(b) For cause or at random;
(c) Using statistical sampling methods and projections based on sample findings; and
(d) At or away from your place(s) of business.
(3) We must provide you with ten working days written notice that our auditors intend to review your patient and related billing records at your place(s) of business.
(4) We will not remove original records from your place of business, but we may request copies of your records. If copies are requested, they must be legible and provided to us within thirty calendar days of receiving our request.
[Statutory Authority: RCW 7.68.030, 51.04.020(4) and 51.04.030. WSR 99-07-004, § 296-31-072, filed 3/4/99, effective 4/4/99. Statutory Authority: RCW 43.22.050. WSR 92-23-033, § 296-31-072, filed 11/13/92, effective 12/14/92.]
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