Hospital billing changes for dental services provided to managed care clients, effective 1/1/2020

Washington State Health Care Authority sent this bulletin at 12/16/2019 09:50 AM PST

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Apple Health (Medicaid) Provider Alert

This billing change applies only to clients enrolled in an agency-contracted managed care organization (MCO).

Effective dates of service on and after January 1, 2020, hospital charges for dental services must be billed directly to the client’s MCO. This includes inpatient, outpatient, emergency department, and ambulatory surgery centers. Do not bill the Health Care Authority (HCA) through fee-for-service for these charges.

The following fees will still be billed directly to HCA through fee-for-service:

Dental professional fees billed using CDT codes;
Dental and/or oral surgeon professional fees using a CPT code and the provider taxonomy starts with a 12.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than two million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Hospital billing changes for dental services provided to managed care clients, effective 1/1/2020

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination