WSR 99-07-004

PERMANENT RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed March 4, 1999, 3:22 p.m. ]

Date of Adoption: March 4, 1999.

Purpose: Two of the rules are unnecessary or obsolete and are being repealed, one is being updated with housekeeping amendments, and the others are being rewritten in language that can be more clearly understood.

Citation of Existing Rules Affected by this Order: Amending WAC 296-30-020 Vehicular assault, 296-30-060 Requirement to report criminal acts, 296-30-081 Acceptance of rules and fees for medical and mental health services, 296-30-900 Effective date of amendatory acts, 296-31-040 Special programs, 296-31-071 Keeping of records, 296-31-072 Review of mental health service providers, 296-31-073 Utilization management, 296-31-075 Excess recoveries and 296-31-080 Billing procedures; and new section and 296-31-085 Can out-of-state providers bill the department?; and repealing WAC 296-30-025 Medical assistance eligibility and 296-31-100 Severability.

Statutory Authority for Adoption: WAC 296-30-020 is RCW 7.68.020, 7.68.030; WAC 296-30-060 is RCW 7.68.060 (1)(b), 7.68.030; WAC 296-30-900 and 296-31-040 is RCW 7.68.030; WAC 296-31-071, 296-31-072 and 296-31-073 is RCW 7.68.030, 51.04.020(4), 51.04.030; WAC 296-31-075 is RCW 7.68.030, 7.68.050, 7.68.130; WAC 296-30-081, 296-31-080, and 296-31-085 is RCW 7.68.030, 7.68.080, 7.68.120, 51.36.010, 51.04.020 (1) and (4), 51.04.030.

Adopted under notice filed as WSR 99-01-179 on December 23, 1998.

Changes Other than Editing from Proposed to Adopted Version: Subsection (6) was added to WAC 296-31-040 to clarify that requests for special agreements with the program must be made in writing. This was stated in another rule, but is related to special agreements and is more appropriate in WAC 296-31-040.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 10, Repealed 2.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 10, Repealed 2.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 10, Repealed 2. Effective Date of Rule: Thirty-one days after filing.

March 1, 1999

Gary Moore

Director

OTS-2543.2


AMENDATORY SECTION(Amending WSR 94-02-015, filed 12/23/93, effective 1/24/94)

WAC 296-30-020
((Vehicular assault.)) Who is covered when a motor vehicle crime occurs?

((Chapter 7.68 RCW shall cover those people killed or injured as a result of a vehicular assault that occurred after July 24, 1983 if there has been a conviction for the vehicular assault.  Eligibility occurs when the claimant's injury results in the assailant's conviction for vehicular assault, or when the claimant's injury is a direct result of the collision that led to the vehicular assault conviction.  The claimant's injury need not be the one that led to the conviction.)) The Crime Victims Act covers injury or death in motor vehicle crimes covered by RCW 7.68.020 (2)(a). Anyone injured or killed in the accident is eligible for benefits.

[Statutory Authority: Chapter 7.68 RCW.  94-02-015, 296-30-020, filed 12/23/93, effective 1/24/94; 86-01-028 (Order 85-37), 296-30-020, filed 12/11/85; 85-03-060 (Order 85-3), 296-30-020, filed 1/15/85.]


AMENDATORY SECTION(Amending WSR 97-02-090, filed 12/31/96, effective 1/31/97)

WAC 296-30-060
((Requirement to report criminal acts.))Who does a victim report the crime to in order to meet reporting requirements?

(((1) The following are examples under which the twelve-month reporting requirement in RCW 7.68.060 (1)(b) may be tolled:

(a) Unconsciousness or coma of victim.

(b) Youth of victim (because of age the victim is unaware that a crime has been committed against her).

(c) Rape trauma syndrome or medical condition affecting the victim's capacity to act.

(d) A report of an assault against a child made to children's protective services when the report is made within twelve months of when it reasonably could have been made.

(2) This list is not and should not be considered exhaustive but is for illustrative purposes.)) The crime can be reported to any of the following:

(1) Local law enforcement (city, county or state police agencies);

(2) Federal police;

(3) Indian tribal police;

(4) Military police; or

(5) Child protective services (CPS) when they have reported to local police.

[Statutory Authority: RCW 51.36.010, 7.68.030, 51.04.020 (1) and (4), 51.04.030, 7.68.080 and 7.68.120.  97-02-090, 296-30-060, filed 12/31/96, effective 1/31/97.  Statutory Authority: Chapter 7.68 RCW.  94-02-015, 296-30-060, filed 12/23/93, effective 1/24/94; 86-01-028 (Order 85-37), 296-30-060, filed 12/11/85; 85-03-060 (Order 85-3), 296-30-060, filed 1/15/85.]


AMENDATORY SECTION(Amending WSR 97-02-090, filed 12/31/96, effective 1/31/97)

WAC 296-30-081
Acceptance of rules and fees for medical and mental health services.

Providing medical or counseling services to an injured crime victim whose claim for crime victims compensation benefits has been accepted by the department constitutes acceptance of the department's medical aid rules and compliance with its rules and fees.  Maximum allowable fees shall be those fees contained in the publications entitled Medical Aid Rules and Fee Schedules and Crime Victims Compensation Program Mental Health Treatment Rules and Fees, less any available benefits of public or private collateral resources, except as follows:

((The percentage of allowed charges authorized by WAC 296-23A-105: Payment for hospital inpatient and outpatient services, WAC 296-23A-155: New hospitals, WAC 296-23A-160(3): Excluded and included services, and WAC 296-23A-165: Out-of-state hospitals shall be equal to the percentage of allowed charges established by the department of social and health services under Title 74 RCW and WAC 388-87-070(6): Payment hospital inpatient services.)) The percent of allowed charges authorized for hospital inpatient and outpatient services billed by revenue code are those rates established by the department of social and health services under Title 74 RCW and WAC 388-550-4500 (1)(a) and 388-550-6000 (1)(a).

If any of the maximum allowable fees in the publications entitled Medical Aid Rules and Fee Schedules and Crime Victims Compensation Program Mental Health Treatment Rules and Fees is lower than the maximum allowable fees for those procedures established by the department of social and health services under Title 74 RCW, the Title 74 RCW fees are the maximum allowable fees for those procedures.

Prior to the establishment or amendment of the fee schedules, the department will give at least thirty calendar days notice by mail to interested persons who have made timely request for advance notice of the establishment or amendment of the fee schedules.  To request advance notice of the establishment or amendment of the medical fee schedules, interested persons must contact the department at the following address:


Department of Labor and Industries

Health Services Analysis

P.O. Box 44322

Olympia, WA 98504-4322


To request advance notice of the establishment or amendment of the mental health fee schedules, interested persons must contact the department at the following address:


Department of Labor and Industries

Crime Victims Compensation Section

P.O. Box 44520

Olympia, WA 98504-4520


An injured victim shall not be billed for his or her accepted injury.  The department shall be billed only after available benefits of public or private insurance have been determined.  Bills must be submitted within ninety days from the date of service to be considered for payment.  If insurance or public agency collateral resources exist, bills must be received within ninety days following payment or rejection by the resource.  A copy of the payment or rejection must accompany the bill.

If the service provider has billed the injured victim and is later notified that the department has accepted the victim's claim, the provider shall refund to the injured victim any amounts paid, and bill the department for services rendered at their usual and customary fees if such rates are in excess of the public or private insurance entitlements.

On claims closed over ninety days, the department will pay for completion of a reopening application (Code 1041M), an office visit and diagnostic studies necessary to complete the application. No other benefits will be paid until the adjudication decision is rendered. When reopening is granted, the department can pay benefits for a period not to exceed sixty days prior to the date the reopening application is received by the department.

Providers outside of the state of Washington are subject to the same requirements, and are paid the same fees, as providers inside the state, with the exception of independent medical or mental health examinations, which will be paid at the examiner's usual customary fee.

[Statutory Authority: RCW 51.36.010, 7.68.030, 51.04.020 (1) and (4), 51.04.030, 7.68.080 and 7.68.120.  97-02-090, 296-30-081, filed 12/31/96, effective 1/31/97.  Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030.  95-15-004, 296-30-081, filed 7/5/95, effective 8/5/95.  Statutory Authority: Chapter 7.68 RCW.  94-02-015, 296-30-081, filed 12/23/93, effective 1/24/94; 92-23-034, 296-30-081, filed 11/13/92, effective 12/14/92; 92-16-033, 296-30-081, filed 7/30/92, effective 8/30/92; 86-01-028 (Order 85-37), 296-30-081, filed 12/11/85.]


AMENDATORY SECTION(Amending WSR 97-02-090, filed 12/31/96, effective 1/31/97)

WAC 296-30-900
((Effective date of amendatory acts.)) What law controls a claim if a statute is amended after the date of the criminal act?

((The statute in effect at the time the criminal act occurred is the controlling law.)) The statute in effect when the criminal act occurred is the controlling law. The act occurs when the perpetrator commits the criminal conduct.

[Statutory Authority: RCW 51.36.010, 7.68.030, 51.04.020 (1) and (4), 51.04.030, 7.68.080 and 7.68.120.  97-02-090, 296-30-900, filed 12/31/96, effective 1/31/97.  Statutory Authority: Chapter 7.68 RCW.  85-03-060 (Order 85-3), 296-30-900, filed 1/15/85.]


REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 296-30-025Medical assistance eligibility.

OTS-2544.3


AMENDATORY SECTION(Amending WSR 92-23-033, filed 11/13/92, effective 12/14/92)

WAC 296-31-040
((Special programs.)) Can the department purchase or authorize a special service or treatment that does not appear in its fee schedule?

(((1) The department may enter into special agreements for services or special treatment modalities or services provided by community based mental health treatment centers, rape crisis centers, domestic violence shelters, medical facilities, and medical facility based sexual assault treatment centers, provided under the direction of registered providers authorized to bill the department.  Special agreements are for services or treatment modalities other than routine services or treatment modalities covered under the fee schedule, and may include, but are not limited to, group counseling, crisis counseling, and emergency assistance and referral programs, or multidisciplinary or inter-disciplinary programs such as day treatment, drug, alcohol, and chemical dependency treatment.

(2) The department shall establish payment rates for special agreements or treatment modalities, and may establish outcome criteria, measures of effectiveness, minimum staffing levels, certification requirements, special reporting requirements, and such other criteria as will ensure that claimants receive good quality and effective services treatment at the least cost, consistent with necessary services.

(3) Special agreements shall be purchased or authorized at the discretion of the department.  The department may terminate special programs from the crime victims compensation program upon thirty days notice to the provider.)) (1) We may purchase and/or authorize agreements for service or treatment not covered in the fee schedule.

(2) The service or treatment must be provided by registered providers authorized to bill the department.

(3) We must establish payment rates for special agreements for service or treatment that we purchase or authorize.

(4) We may establish criteria to ensure each claimant receives quality and effective service or treatment that is provided at the least cost and is consistent with necessary services. Examples include, but are not limited to, outcome criteria, measures of effectiveness, minimum staffing levels, certification requirements, and special reporting requirements.

(5) We may terminate a special agreement by giving the provider thirty days written notice.

(6) Any request for a special agreement must be made in writing to the crime victims' compensation program.

[Statutory Authority: RCW 43.22.050.  92-23-033, 296-31-040, filed 11/13/92, effective 12/14/92.]


AMENDATORY SECTION(Amending WSR 92-23-033, filed 11/13/92, effective 12/14/92)

WAC 296-31-071
((Keeping of records.)) What records must providers maintain?

((A provider who requests payment from the department for services shall maintain all patient and billing records necessary for the director's authorized auditors to audit the provision of services.  A provider shall keep all records necessary to disclose the extent of services furnished to claimants or their family members.  These records shall be provided to department representatives upon request and at a minimum, these records shall include specific documentation of the level and type of service for which payment is sought.  Records must be maintained for audit purposes for a minimum of five years from the date of the last treatment of the claimant.

The confidentiality concerning the safeguarding and release of claimant personal information is governed under RCW 7.68.140 and 7.68.145 of the Crime Victims Act.  The department may be contacted for brochures and copies of the act.)) If providers request payment from us for service, they must:

(1) Maintain all patient and billing records needed to:

(a) Determine the extent of services provided to claimants or to their family members. Each record must, at a minimum:

(i) Document the level and type of service provided; and

(ii) Where applicable, indicate the name of our representative who authorized equipment or treatment.

(b) Comply with our audit of services, if an audit is authorized.

(2) Maintain records for audit purposes for at least five years from the claimant’s last treatment date.

(3) Provide records to us, if requested.

Note:The confidentiality (safeguarding and release) of a claimant’s records is governed by RCW 7.68.140 and 7.68.145 of the Crime Victims Act.

[Statutory Authority: RCW 43.22.050.  92-23-033, 296-31-071, filed 11/13/92, effective 12/14/92.]


AMENDATORY SECTION(Amending WSR 92-23-033, filed 11/13/92, effective 12/14/92)

WAC 296-31-072
((Review of mental health services providers.)) Are provider records subject to a health care services review or an audit?

(((1) The department may review providers' patient and billing related records to ensure claimants are receiving proper and necessary care and to ensure providers' compliance with the department's 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 services.  Records reviews may be conducted 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, except as authorized in WAC 296-18A-460, 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 mental health rules and standards.

(4) The provider shall provide, in lieu of originals, legible copies of providers' records if requested by the department.  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.)) (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 43.22.050.  92-23-033, 296-31-072, filed 11/13/92, effective 12/14/92.]


AMENDATORY SECTION(Amending WSR 92-23-033, filed 11/13/92, effective 12/14/92)

WAC 296-31-073
((Utilization management.)) Can the department enlist utilization review or management programs?

((The department, as a trustee of funds appropriated by legislature, has a duty to supervise the provision of proper and necessary mental health care that is delivered promptly, efficiently, and economically.  Toward this end, the department uses utilization management programs.  These programs are designed to monitor and control the proper and necessary use and cost of services.

These programs include, but are not limited to, managed care contracting, prior authorization for services, and alternative reimbursement systems.)) As a trustee of funds appropriated by the legislature, we have a duty to supervise the provisions of proper and necessary mental health care. We may enlist utilization review or management programs to monitor and control the delivery, use, and cost of necessary mental health care services. Examples include, but are not limited to, managed care contracting, prior authorization of services, and alternative reimbursement systems.

[Statutory Authority: RCW 43.22.050.  92-23-033, 296-31-073, filed 11/13/92, effective 12/14/92.]


AMENDATORY SECTION(Amending WSR 95-15-004, filed 7/5/95, effective 8/5/95)

WAC 296-31-075
((Excess recoveries.)) What is excess recovery?

((In cases where a recovery has been made resulting in an excess recovery subject to offset from the future benefits or compensation due, the department is not liable for payment for services rendered by providers.  The claimant is responsible for payment at department fee schedule rates.  The claimant should be treated and the department billed in accordance with these mental health treatment rules and instructions.  When bills are processed against the amount of the excess recovery, the department will notify the provider.  The department will resume financial responsibility to or on behalf of the claimant when the amount of such excess has been reduced to zero.  Charges for reports, consultations and other actions required of providers by the department solely for the purpose of the department's management of claims will be paid by the department during the period within which the excess recovery is being reduced.)) The remaining balance of a recovery, which is paid to the victim but must be used to offset future payment of benefits.

How does excess effect the bill payment process?

(1) When an excess recovery exists, the department is not responsible for payment of bills.

(2) The provider must bill the department in accordance with the department’s medical aid rules and maximum fee schedules.

(3) The department will:

(a) Determine the amount payable according to the fee schedule;

(b) Credit the excess recovery with the amount payable; and

(c) Send the provider a remittance advice showing the amount due from the victim.

(4) The victim must pay the provider in accordance with the remittance advice.

(5) When the excess is reduced to zero the department will resume responsibility for payment of bills.

[Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030.  95-15-004, 296-31-075, filed 7/5/95, effective 8/5/95.  Statutory Authority: RCW 43.22.050.  92-23-033, 296-31-075, filed 11/13/92, effective 12/14/92.]


AMENDATORY SECTION(Amending WSR 97-02-090, filed 12/31/96, effective 1/31/97)

WAC 296-31-080
((Billing procedures.)) How do providers bill for services?

(((1) All services rendered must be in accordance with these mental health treatment rules.  The department may reject bills for services rendered in violation of these rules.  The claimant may not be billed for services rendered in violation of these rules.  However, claimants may be billed if they fail to keep or miss a properly scheduled appointment.

Providers shall bill their usual and customary fee for services.  If a usual and customary fee for any particular service is lower to the general public than listed in the fee schedules, the practitioner shall bill the department at the lower rate.

(a) Bills must be itemized on department forms or other forms which have been approved by the department.  Physicians, advanced registered nurse practitioners, psychologists, and masters level mental health counselors may use the National Standard HCFA 1500 Health Insurance Claim Form or the department's statement for crime victim services.  When billing for treatment of a family member other than the claimant, you must identify the family member by name and relationship to the claimant.  Hospitals use the UB-92 billing form for institution services and the National Standard HCFA 1500 Health Insurance Claim Form for professional services.

(b) Bills must specify the date and type of service, the appropriate procedure code, the condition treated, and the charges for each service.

(c) Every bill submitted to the department must be completed to include the following:

(i) Claimant's name and address;

(ii) Claimant's claim number;

(iii) Date of injury;

(iv) Referring provider's name;

(v) Dates of service;

(vi) Place of service;

(vii) Type of service;

(A) Psychiatrists and psychologists use type of service 3.

(B) Master level counselors use type of service M.

(C) Advanced registered nurse practitioners (ARNP) use type of service N.

(viii) Appropriate procedure code or hospital revenue code;

(ix) Description of service; if mental health patient is not the claimant, give name and relationship to the claimant;

(x) Charge;

(xi) Units of service;

(xii) Total bill charge;

(xiii) Provider of service;

(xiv) Group, clinic, center, or facility name;

(xv) Billing address;

(xvi) Federal tax information;

(A) Federal tax identification number; or

(B) Social Security number.

(xvii) Date of billing;

(xviii) Submission of supporting documentation required under (f) of this subsection;

(xix) Private or public insurance eligibility and amounts paid.

(d) Responsibility for the completeness and accuracy of the description of services and charges billed rests with the provider rendering the service, regardless of who actually completes the bill form.

(e) Providers are urged to bill on a monthly basis.  Bills must be submitted within ninety days from the date of service to be considered for payment.  If insurance or public agency collateral resources exist bills must be received within ninety days following payment or rejection by the resource.  A copy of the payment or rejection must accompany the bill.

(f) The following supporting documentation must be maintained and submitted when billing for services, as may be appropriate:

(i) Intake evaluation;

(ii) Progress reports;

(iii) Consultation reports;

(iv) Special or diagnostic study reports;

(v) Independent assessment or closing exam reports;

(vi) For BR procedures - see WAC 296-31-090 for requirements;

(vii) Claimant public or private insurance information.

(g) The claim number must be placed in the upper right hand corner on each bill and on each page of reports and other correspondence.

(h) Rebills.  If a provider does not receive payment or notification from the department within ninety days, services may be rebilled.  Rebills must be submitted for services denied if a claim is closed or rejected and subsequently reopened or allowed.  Rebills should be identical to the original bill: Same charges, codes, and billing date.  The statement "rebill" must appear on the bill.

(i) Any inquiries regarding adjustment of charges must be submitted within ninety days from the date of payment to be considered.

(j) Any denied charge may be protested in writing to the department or appealed to the board of industrial insurance appeals.

(2) Allowance and payment for medication.  The department will pay for medications or supplies dispensed for the treatment of conditions resulting from a crime victim injury and/or conditions which are retarding the recovery from the claimant's condition, for which the department has accepted temporary responsibility.  Specific information governing allowance and payment for medication is contained in WAC 296-20-17001.

(3) Payment of out-of-state providers.

(a) Providers of mental health services located outside of the state of Washington shall bill their usual and customary fees and will be paid according to the Washington state crime victims compensation program mental health treatment rules and fees.

(b) Independent medical exams (independent assessments) shall be billed and paid according to the examiner's usual and customary fee.

(c) In all cases these payment levels are the maximum allowed to providers of services to claimants.  Should a provider's charge exceed the payment amount allowed under the state of Washington crime victim compensation program rules, the provider is prohibited from charging the claimant for the difference between the provider's charge and the allowable rate.  Providers violating this provision are ineligible to treat claimants as provided by these mental health rules and are subject to other applicable penalties.

(d) Only those diagnostic and treatment services authorized under the state of Washington mental health rules may be allowed by the department.  As determined by the department, the scope of practice of providers in bordering states may be recognized for payment purposes, except that in all cases WAC 296-20-03002 (treatment not authorized) shall apply.  Specifically, services permitted under crime victims compensation programs in the provider's place of business, but which are not allowed chapters 296-20, 296-30, and 296-31 WAC of the state of Washington, may not be reimbursed.  When in doubt, the provider should verify coverage of a service with the department.

(e) Out-of-state hospitals will be paid according to WAC 296-30-081.)) (1) Neither the department nor the claimant is required to pay for provider services which violate the mental health treatment rules, fee schedule or department policy.

(2) All fees listed are the maximum fees allowable. Providers must bill their usual and customary fee for each service. If this is less than our fee schedule rate, you must bill us at the lesser rate. The department will pay the lesser of the billed charge or the fee schedule’s maximum allowable.

The provider is prohibited from charging the claimant for any difference between the provider’s charge and our allowable amount.

(3) Regardless of who completes the bill form, you are responsible for the completeness and accuracy of the description of services and of the charges billed.

(4) All bills submitted to the department must:

(a) Be itemized on forms approved by us.

For example: Physicians, psychologists, advanced registered nurse practitioners and master level mental health counselors may use our form or the national standard HCFA 1500 health insurance claim form. Hospitals use the UB 92 billing form for institution services and the national standard HCFA 1500 health insurance claim form for professional services.

(b) Refer to the crime victims compensation program mental health treatment rules and fees booklet for procedure code listings and detailed billing instructions. Billings must be submitted in accordance with this publication.

(5) The following supporting documentation must be maintained and, if applicable, submitted when billing for services:

(a) Intake evaluation;

(b) Progress reports;

(c) Consultation reports;

(d) Special or diagnostic study reports;

(e) Independent assessment or closing exam reports;

(f) BR (by report) describing why a service or procedure is too unusual, variable, or complex to be assigned a value unit;

(g) The claimant’s or patient’s (if patient is other than claimant) private or public insurance information;

For example: When services provided are for survivors of homicide victims.

(6) The claim number must appear in the appropriate field on each bill form. Reports and other correspondence must have the claim number in the upper right hand corner of each page.

(7) You may rebill us if your bill is not reported on your remittance advice within sixty days. Unless the information on the original bill was incorrect, a rebill should be identical. Rebills must be submitted for services denied if a claim is closed or rejected and subsequently reopened or allowed.

(8) We will adjust charges when appropriate. We must provide you with a written explanation as to why a billing was adjusted. A written explanation is not required if the adjustment was made solely to conform to our maximum allowable fees. Any inquiries regarding adjustment of charges must be received in the required format within ninety days from the date of payment.

[Statutory Authority: RCW 51.36.010, 7.68.030, 51.04.020 (1) and (4), 51.04.030, 7.68.080 and 7.68.120.  97-02-090, 296-31-080, filed 12/31/96, effective 1/31/97.  Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030.  95-15-004, 296-31-080, filed 7/5/95, effective 8/5/95.  Statutory Authority: Chapter 7.68 RCW.  94-02-015, 296-31-080, filed 12/23/93, effective 1/24/94.  Statutory Authority: RCW 43.22.050.  92-23-033, 296-31-080, filed 11/13/92, effective 12/14/92.]


NEW SECTION
WAC 296-31-085
Can out-of-state providers bill the department?

(1) Providers of mental health diagnostic and treatment services located outside the state of Washington:

(a) May bill us for services that we allow and are authorized by the crime victims compensation program mental health treatment rules;

(b) Must bill us according to the provisions of this chapter;

(c) Must bill their usual and customary fees; and

(d) Will be paid according to the Washington state crime victims compensation program mental health treatment rules and fees.

Exception: Hospitals located outside the state of Washington are paid according to WAC 296-30-081.

(2) Independent medical or mental health examinations must be billed and will be paid according to the examiner’s usual and customary fee.

(3) We will not reimburse a charge for service(s) allowed under any out-of-state crime victims compensation program unless it is allowed in chapters 296-30 and 296-31 WAC. When in doubt, the provider should contact us to verify coverage.

[]


REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 296-31-100Severability.

Washington State Code Reviser's Office