Section 246-130-030. How does the early intervention program pay a provider or benefits manager?

The department pays a provider or benefits manager for covered services delivered to clients, as limited by this section.

(1) The department pays a provider or benefits manager who contracts with the department for services described in WAC 246-130-020.

(a) The department will only pay for services delivered by a contracted provider or benefits manager.

(b) A provider or benefits manager must bill the department according to the procedure and terms of the contract.

(c) The department only pays for covered, medically necessary early intervention program services delivered to clients who are eligible under WAC 246-130-040.

(2) Payment of services depends on availability of federal and state funds. The department will not deny payment of any individual claim for funding availability unless the department denies an entire class of claims, or an entire program.

(3) A provider or benefits manager who disputes a payment may do so through the contracts process specified in WAC 246-130-080(3).

(4) The department is payer of last resort.

(a) A provider or benefits manager must bill all other third-party sources prior to billing the department for covered services; and

(b) A provider or benefits manager must reimburse the department for any funds paid by the department, which were actually reimbursed by other sources.

[Statutory Authority: RCW 43.70.670. WSR 05-23-100, § 246-130-030, filed 11/17/05, effective 12/18/05. Statutory Authority: RCW 43.70.040 and 43.70.120. WSR 00-19-117, § 246-130-030, filed 9/20/00, effective 10/21/00; WSR 95-23-018, § 246-130-030, filed 11/7/95, effective 12/8/95. Statutory Authority: RCW 43.70.120. WSR 92-02-018 (Order 224), § 246-130-030, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-130-030, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.70.120. WSR 90-17-087 (Order 071), § 248-168-030, filed 8/17/90, effective 9/17/90. Statutory Authority: RCW 43.20A.550. WSR 87-22-012 (Order 2549), § 248-168-030, filed 10/26/87.]

RCW 43.70.670. WSR 05-23-100, § 246-130-030, filed 11/17/05, effective 12/18/05. Statutory Authority: RCW 43.70.040 and 43.70.120. WSR 00-19-117, § 246-130-030, filed 9/20/00, effective 10/21/00; WSR 95-23-018, § 246-130-030, filed 11/7/95, effective 12/8/95. Statutory Authority: RCW 43.70.120. WSR 92-02-018 (Order 224), § 246-130-030, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-130-030, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.70.120. WSR 90-17-087 (Order 071), § 248-168-030, filed 8/17/90, effective 9/17/90. Statutory Authority: RCW 43.20A.550. WSR 87-22-012 (Order 2549), § 248-168-030, filed 10/26/87.

Rules

246-130-020,246-130-040,246-130-080,