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WAC 388-835-0720

What general requirements apply to settlements between DSHS and providers?

(1) Except as otherwise provided in this chapter, settlements must be calculated at the lower of a provider's prospective reimbursement rate or audited allowable costs.
(2) Each provider must complete a proposed preliminary settlement as part of their annual cost report. The due date for the proposed preliminary settlement is the same as the due date for the annual cost report. After reviewing the proposed preliminary settlement, DSHS must issue a preliminary settlement report to the provider.
(3) If a field audit is conducted, DSHS must evaluate the audit findings and issue a final settlement that incorporates the auditor's findings and DSHS's evaluation.
(4) If according to a preliminary or final settlement and the procedures in this chapter, a provider received overpayments from DSHS, they must refund those overpayments to the department. Conversely, DSHS must pay provider for any underpayments for which the department is responsible.
(5) Following a preliminary or final settlement, payment for services must be at the most recent available settlement rate.
[Statutory Authority: RCW 71A.20.140. WSR 01-10-013, ยง 388-835-0720, filed 4/20/01, effective 5/21/01.]
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