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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.
The agency apologizes for any
inconvenience.
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