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PDFWAC 388-835-0905

What happens after a provider requests an administrative review?

(1) After receiving a provider's request, DSHS must schedule a conference between the provider and appropriate department representatives.
(2) Unless both parties agree, in writing, to a specific later date, the conference must be scheduled at least fourteen days after DSHS notifies the provider that a conference will be held and no later than ninety days after DSHS receives the provider's review request.
(3) The conference may be conducted by telephone unless DSHS or the provider requests, in writing, that it be held in person.
(4) The provider and DSHS representatives must participate in the conference.
(5) Either at the conference or before, the provider must give DSHS any documentation:
(a) Requested by DSHS that the provider is required to maintain for audit purposes under WAC 388-835-0270; and
(b) The provider intends to use to support their position.
(6) At the conference DSHS and the provider must clarify the issues and attempt to resolve them.
(7) If additional documentation is necessary to resolve the issues, a second conference meeting must be scheduled. Unless both parties agree, in writing, to a specific later date, this second conference meeting must be scheduled not later than thirty days after the first session.
(8) Regardless of whether an agreement is reached, DSHS must give the provider a written decision within sixty days after the conference ends.
[Statutory Authority: RCW 71A.20.140. WSR 01-10-013, ยง 388-835-0905, filed 4/20/01, effective 5/21/01.]
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