# RCW 48.200.220: RCW 48.200.220: Auditing of claims—Requirements—Prohibited practices

> Washington · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S220

## Section

- **Citation:** RCW 48.200.220
- **Heading:** RCW 48.200.220: Auditing of claims—Requirements—Prohibited practices
- **Jurisdiction:** Washington
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Washington Code / Title 48 / Chapter 200 / Section 220

## Text

An entity that audits claims or an independent third party that contracts with an entity to audit claims: (1) Must establish, in writing, a procedure for a pharmacy to appeal the entity's findings with respect to a claim and must provide a pharmacy with a notice regarding the procedure, in writing or electronically, prior to conducting an audit of the pharmacy's claims; (2) May not conduct an audit of a claim more than twenty-four months after the date the claim was adjudicated by the entity; (3) Must give at least fifteen days' advance written notice of an on-site audit to the pharmacy or corporate headquarters of the pharmacy; (4) May not conduct an on-site audit during the first five days of any month without the pharmacy's consent; (5) Must conduct the audit in consultation with a pharmacist who is licensed by this or another state if the audit involves clinical or professional judgment; (6) May not conduct an on-site audit of more than two hundred fifty unique prescriptions of a pharmacy in any twelve-month period except in cases of alleged fraud; (7) May not conduct more than one on-site audit of a pharmacy in any twelve-month period; (8) Must audit each pharmacy under the same standards and parameters that the entity uses to audit other similarly situated pharmacies; (9) Must pay any outstanding claims of a pharmacy no more than forty-five days after the earlier of the date all appeals are concluded or the date a final report is issued under RCW 48.200.260 (3); (10) May not include dispensing fees or interest in the amount of any overpayment assessed on a claim unless the overpaid claim was for a prescription that was not filled correctly; (11) May not recoup costs associated with: (a) Clerical errors; or (b) Other errors that do not result in financial harm to the entity or a consumer; and (12) May not charge a pharmacy for a denied or disputed claim until the audit and the appeals procedure established under subsection (1) of this section are final.

## Nearby sections

- [RCW 48.200.010 RCW 48.200.010: Findings—Intent.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S010.md)
- [RCW 48.200.020 RCW 48.200.020: Definitions.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S020.md)
- [RCW 48.200.030 RCW 48.200.030: Registration requirements—Application—Fees—Retention of transaction records.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S030.md)
- [RCW 48.200.040 RCW 48.200.040: Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S040.md)
- [RCW 48.200.050 RCW 48.200.050: Inquiries or complaints—Violations of chapter—Enforcement actions—Responsibility of carriers and programs for compliance.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S050.md)
- [RCW 48.200.210 RCW 48.200.210: Definitions applicable to RCW 48.200.220 through 48.200.290.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S210.md)
- [RCW 48.200.220 RCW 48.200.220: Auditing of claims—Requirements—Prohibited practices.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S220.md)
- [RCW 48.200.230 RCW 48.200.230: Basis of finding of claim.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S230.md)
- [RCW 48.200.240 RCW 48.200.240: Contract with third party—Prohibited practices.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S240.md)
- [RCW 48.200.250 RCW 48.200.250: Evidence of validation of claim.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S250.md)
- [RCW 48.200.260 RCW 48.200.260: Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S260.md)
- [RCW 48.200.270 RCW 48.200.270: Application.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S270.md)
- [RCW 48.200.280 RCW 48.200.280: Predetermination of reimbursement costs—Appeals—Review by commissioner.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S280.md)
- [RCW 48.200.290 RCW 48.200.290: Enforcement—Disputes—Civil penalties.](https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S290.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_T48_C200_S220. Check the current official text before relying on it. Not legal advice.