Washington Administrative Code › Title 182 - Health Care Authority › ALL PAYER HEALTH CARE CLAIMS DATABASE › Chapter 182-70 - All payer health care claims database › AUDITS › Section 182-70-710 - Audit process

Current through Register Vol. 24-14, July 15, 2024
(1) Once the
				  authority determines an audit will be conducted, either as a random audit or
				  based on a triggering event set forth in WAC 182-70-705(2), the authority shall
				  provide written notice to the subject of the audit at least thirty days before
				  the start of the audit. The notice must include the name of the company or
				  individuals who will be conducting the audit and the subject of the audit,
				  including the time period for which the audit covers, which time period must be
				  no longer than the prior three years. If the audit is the result of a
				  triggering event, the notice will include information regarding the triggering
				  event. The notice will also include information regarding the audit entrance
				  conference that has been scheduled to take place within fourteen days before
				  the audit will begin. The notice will include the location, date and time and
				  contact person for the entrance conference and such other information as
				  required. The authority will work with the subject of the audit to ensure
				  sufficient time is provided between providing the written notice, the date of
				  the entrance conference, and the start of the audit.
(2) The subject of the audit is required to
				  cooperate with the auditor, providing the information as requested. If there is
				  a dispute during the audit, the issue should be brought to the attention of the
				  WA-APCD program director, who will resolve the dispute. Both the auditor and
				  the subject of the audit will be provided an opportunity to present its issues
				  regarding the dispute, either in writing or in person. The WA-APCD program
				  director may engage a mediator to help resolve the dispute.
(3) The auditor will be required to prepare
				  an audit report. A draft of the audit report shall be provided to the subject
				  of the audit for review and comments. The subject of the audit should be
				  provided no less than thirty days to provide comment to the draft
				  report.
(4) After receiving and
				  reviewing any comments, and revising the draft audit report as deemed
				  necessary, the auditor shall schedule an exit conference with the subject of
				  the audit to review the audit and final audit report. The subject of the audit
				  shall be provided an opportunity to submit comments or responses to the
				  findings in the audit. The auditor shall provide a deadline, not less than
				  thirty days after the exit conference for submission of any response to the
				  audit.
(5) The auditor shall issue
				  a final audit report no later than thirty days after the deadline for
				  submission of any response. The report shall be provided to the authority and
				  the subject of the audit. The final report shall include any response provided
				  by the subject of the audit. The authority shall publish the final report on
				  the agency website.
(6) The auditor
				  shall be required to sign a confidentiality/nondisclosure agreement if the
				  auditor will have access to any confidential or proprietary
				  information.
Statutory Authority:
						RCW 43.371.070.
						WSR 18-22-095, §
												82-75-710, filed
						11/5/18, effective 12/6/18.