|
The Health Care Authority (HCA) is providing this quick reference for Apple Health (Medicaid) providers, accompanied by the 2025 Annual Medicaid Provider Audit Training.
What is RCW 74.09.192?
RCW 74.09.192 is a Washington State law that outlines how Apple Health provider audits must be conducted. It ensures fairness, transparency, and due process for all providers.
How much notice will I receive before an audit?
You will receive at least 30 calendar days’ written notice before an audit.
Exceptions: Suspected fraud or urgent public health risks.
How can I submit records?
You may submit documentation electronically, including CD, DVD, fax, or secure digital formats.
Can the agency review the same claim more than once?
HCA makes reasonable effort to avoid reviewing the same claim more than once.
What happens if the audit identifies findings?
The provider will receive a written explanation that includes:
- Specific audit results.
- Appeal rights.
- Instructions for corrections or adjustments.
How long does the agency have to issue a preliminary report?
A preliminary audit report must be issued within 120 days after all requested records are received.
What are my responsibilities during an audit?
- Respond promptly to audit notices.
- Submit complete and accurate documentation.
- Review findings carefully.
- Appeal if you disagree.
- Communicate with the lead auditor, found on the audit notice.
|
