RCW 48.200.230
Basis of finding of claim.
An entity's finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation, or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs.
[ 2014 c 213 § 5. Formerly RCW 19.340.050.]
Structure Revised Code of Washington
Chapter 48.200 - Health Care Benefit Managers.
48.200.030 - Registration requirements—Application—Fees—Retention of transaction records.
48.200.210 - Definitions applicable to RCW 48.200.220 through 48.200.290.
48.200.220 - Auditing of claims—Requirements—Prohibited practices.
48.200.230 - Basis of finding of claim.
48.200.240 - Contract with third party—Prohibited practices.
48.200.250 - Evidence of validation of claim.
48.200.280 - Predetermination of reimbursement costs—Appeals—Review by commissioner.
48.200.290 - Enforcement—Disputes—Civil penalties.