Pol-0268-3 Identifying Possible Provider Overpayments

Effective date: 10/1/2018

See also: WAC 110-15-0268

Revisions: Policy Manual Revision Log

Policy

This policy applies to when a potential provider overbilling issue is discovered while reviewing an overpayment for a client.

  1. DCYF refers suspected billing issues to the DCYF QA team including:
    1. Licensed/certified providers who consistently claim the maximum number of units authorized, (i.e., 23 full-days, 23 to 30 half days per month).
    2. Family/Friend & Neighbor (FFN) providers who consistently bill for the maximum authorized units per month.
    3. FFN providers who claim for more than 6 children for the same time period (overlapping days and hours).
    4. FFN providers who claim payment for non-school/holiday hours (contingency hours) for which they are not eligible.