DSHS Form 06-124 Cost of Care Adjustment Request - Washington

What Is DSHS Form 06-124?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 06-124?A: The DSHS Form 06-124 is the Cost of Care Adjustment Request form used in Washington.

Q: What is the purpose of DSHS Form 06-124?A: The purpose of the DSHS Form 06-124 is to request an adjustment to the cost of care for services provided in Washington.

Q: Who can use DSHS Form 06-124?A: Any individual or their legal representative receiving services from the Department of Social and Health Services (DSHS) in Washington can use this form to request an adjustment to the cost of care.

Q: What information is required on DSHS Form 06-124?A: The form requires information such as the client's name, case number, provider information, requested adjustment amount, and supporting documentation.

Q: Is there a deadline for submitting DSHS Form 06-124?A: There is no specific deadline mentioned for submitting the DSHS Form 06-124, but it is recommended to submit it as soon as possible to ensure timely processing of the adjustment request.

Q: What happens after I submit DSHS Form 06-124?A: After you submit the DSHS Form 06-124, DSHS will review your request and supporting documentation to determine if an adjustment to the cost of care is warranted.

Q: Can I appeal the decision made on my DSHS Form 06-124?A: Yes, if you disagree with the decision made on your DSHS Form 06-124, you have the right to appeal the decision through the DSHS administrative fair hearing process.