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provider failed to timely file a claim, the department will

(1) approve the appeal and pay the maximum amount allowed under 7 AAC 105 — 7 AAC 160 if the department determines that

(A) the department committed an error on a claim previously submitted by the provider for the same service to the same recipient on the same day;

(B) the claim was timely filed but not processed; or

(C) the provider has good cause under (h) of this section for the provider’s failure to submit the claim before the billing deadline under 7 AAC 145.005(c); or

(2) deny the provider’s appeal if the department determines that the claim was not timely filed. (e) A decision by the department under this section is a final administrative decision, and the department will notify the provider of the provider’s right to appeal to the superior court under the Alaska Rules of Appellate Procedure. (f) The provisions of this section do not apply to recoupment actions resulting from audits conducted under 7 AAC 160.100 — 7 AAC 160.130. (g) Repealed 8/1/2020. (h) The department will find good cause for a provider’s failure to submit a claim before the billing deadline under 7 AAC 145.005(c) if the failure to submit the claim resulted from a condition that was beyond the provider’s control or was caused by a condition that the provider could not reasonably be expected to prevent. In this subsection, a condition beyond the provider’s control or a condition that the provider could not reasonably be expected to prevent

(1) includes

(A) a weather condition that causes a mail or travel delay; and

(B) a disaster such as a fire, flood, or earthquake; and

(2) does not include

(A) provider staffing deficiencies; or

(B) the recipient’s failure to notify the provider of a court, hearing authority, or department decision described in 7 AAC 145.005(c). (Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199; am 8/1/2020, Register 235) Statutory Authority: Authority: AS 44.77.015 AS 47.05.010 AS 47.07.040