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 Washington State Health 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.