SH16-006 Interagency Contract - Laserfiche WebLink

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Contractor's appeal of a Department denial for reimbursement by submitting a written request and any supporting documentation to the Department's Utilization Management Office, Medical Billing It is the responsibility of the Contractor to process payment for all bills prior to sending them to the Department for reimbursement. However, if the Contractor is unable to make payment for direct billings, the Contractor may send a written request to the Department to process payment on the behalf of the Contractor. Requests may be submitted via fax (360) 586-1320 or via email to DOCHQMedicalRAB@DOCI.WA.GOV. Contractors must include a copy of the original medical bill with the request. The Department will respond to the Contractor's written request for assistance with payment of a direct billing(s) not later than 7 business days of receipt. Contractors shall instruct the billing entity to NOT send a medical bill directly to the Department. Contractors shall submit monthly medical billings electronically to the Department's Medical Disbursement Unit at DOCHQMedicalRAB@DOCI.WA.GOV. Monthly itemized invoices for services provided onsite by the Contractor should include the previous month's services. Contractors must submit billings for offsite services within 30 days of the date of service. The Department understands that occasionally a monthly invoice may include medical bills from the previous month(s). However, in an effort to ensure an efficient and accurate billing process, Contractors will submit bills one month at a time, whenever possible. Itemized billing statements must be submitted following the format of the DOC's Medical Billing Reimbursement Form, Attachment C, with the supporting documentation attached, when applicable. Incomplete or missing data or supporting documentation may result in delays or denial of payment. Contractors unable to submit billing via email, must fax bills to: Department of Corrections Medical Disbursement Unit Fax: (360) 586-1320 Monthly billings must include: • A coversheet with all pertinent details including: (1) The medical facility name, the medical facility's Federal Tax ID number, including the name of the contact at the medical facility, the medical facility's contact's phone number, and either an email or fax number; (2) The total amount being billed; (3) The month, date and year of service; State of Washington K9561 (4) Page 22 of 25 Department of Corrections 158362