Washington State Health Care Authority sent this bulletin at 02/01/2016 03:57 PM PST
Provider Alert
Washington
Apple Health (Medicaid), administered by the Health Care Authority (the
agency), is aware of an ongoing billing issue with early refill codes. The
agency is working on this issue and hopes to have it resolved as soon as
possible. The following codes are affected:
Justification
Description
Code
Lost
or Stolen Drug Replacement
5 School
or
Camp
8 Monitoring
8 Suicidal
Risk (SR)
8 Take Home Supply (Skilled Nursing Facility
Client)
8
When
using these codes, you should manually override claims for clients who
meet the justification under pages 71 and 72 of the Prescription
Drug Program Provider Guide.
For
rejected claims, call the agency’s Pharmacy Authorization department at
1-800-562-3022 ext. 15483 between 8:30 a.m. and 4:30 p.m. weekdays.
If
a client’s medical needs are urgent, based on the dispensing pharmacist’s
professional judgment, and you are unable to receive prior authorization by
either fax or phone, the agency encourages you to follow its Emergency
Fill Policy and obtain authorization after the fact when the Pharmacy
Authorization department is available.
Please do
not reply directly to this message. If you have feedback
or questions, please visit the HCA
website for contact information.
About
WashingtonStateHealth Care Authority HCA oversees the state’s top
two health care purchasers — Washington Apple Health (Medicaid) and the Public
Employee Benefits Board Program. We work with partners to help ensure
Washingtonians have access to better health and better care at a lower cost. For
more information, visit www.hca.wa.gov.