Wash. Admin. Code § 296-31-075

Current through Register Vol. 24-21, November 1, 2024

Section 296-31-075 - What is excess recovery?

The remaining balance of a recovery, which is paid to the claimant 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 claimant.

(4) The claimant 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.

Wash. Admin. Code § 296-31-075

Statutory Authority: Chapter 7.68 RCW. 12-23-085, § 296-31-075, filed 11/20/12, effective 1/1/13. Statutory Authority: RCW 7.68.030, 7.68.050 and 7.68.130. 99-07-004, § 296-31-075, filed 3/4/99, effective 4/4/99. 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.