Section 82-75-050. Data submission schedule.

(1) Data suppliers shall submit the required health care data in accordance with the schedule provided in this section.

(2) Test file.

(a) At least sixty calendar days prior to the data suppliers' first required submission, the lead organization will notify the data supplier in writing regarding the obligation to file. The lead organization will schedule time to work with the data supplier to establish a schedule for when the data supplier shall submit the initial test files.

(b) No more than ninety calendar days after notification of changes in requirements in the data submission guide, the data supplier shall submit initial test files. This deadline may be extended by the lead organization when it determines that additional time will be needed in order for the change to be implemented.

(3) Submission file. Data and claim files shall be submitted to the WA-APCD on a quarterly basis. On or before April 30th, July 31st, October 31st and January 31st of each year, data and claim files shall be submitted for all nondenied adjudicated claims paid in the preceding three months.

(4) Resubmission file. Failure to conform to the requirements of this chapter or the data submission guide shall result in the rejection of the applicable data and claim files. The lead organization shall notify the data supplier when data and claim files are rejected. All rejected files must be resubmitted in the appropriate, corrected format within fifteen business days of notification unless a written request for an extension is received by the lead organization before the expiration of this fifteen business day period.

(5) Claims run-out file. If health care coverage is terminated for a Washington covered person, the data supplier shall submit data for a six month period following the health care coverage termination date.

(6) Replacement file.

(a) A data supplier may replace a complete data file, claim file or both data and claim file submission. Requests must be made to the lead organization with a detailed explanation as to why the replacement is needed. The lead organization shall make a recommendation to the office as to whether to approve or deny the request. The approval recommendation shall also state whether the approval is for the entire period requested or for a period less than requested.

(b) The office shall approve or deny the request and provide written notification to the requestor within thirty calendar days of receipt of the request. The office decision on the request for a replacement file will be provided in writing. If the office does not approve the complete request for a replacement file, the written notification will include the reason for the denial or approval of the shorter period of time.

(c) Requests may not be made more than one year after the end of the month in which the file was submitted unless the data supplier can establish exceptional circumstances for the replacement. The lead organization may recommend approval and the office may approve a request for more than one year for exceptional circumstances. The office shall approve or deny the request using the process set forth in (b) of this subsection.

[Statutory Authority: Chapter 43.371 RCW. WSR 16-04-068, § 82-75-050, filed 1/29/16, effective 2/29/16.]

Chapter 43.371 RCW. WSR 16-04-068, § 82-75-050, filed 1/29/16, effective 2/29/16.