Provider Alert

September 23, 2016

Multiple fills - change in billing

Attention Pharmacies,

When billing for a medication more than twice in one month or to fill a prescription early as a replacement for a lost or stolen medication, the agency previously provided pharmacies with the following codes to receive reimbursement in situations where the agency allows multiple fills or early refills:

Justification Description                                       PA Type 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

Recently these codes were temporarily unavailable. Pharmacies had to call the agency’s Pharmacy Authorizations for an override.

Effective immediately, these codes are available again for these situations. However, pharmacies must now enter the code in both the PA Type and PA number fields as shown below: 
                                                                                      
                                                                                Code for                          Code for
Justification Description                             PA Type Code field              PA Number field

Lost or stolen drug replacement                                       5                                        5
School or camp                                                               8                                        8
Suicidal risk (SR)                                                            8                                        8
Take home supply (skilled nursing facility client)              8                                        8

The Prescription Drug Program Billing Guide will be updated with this information by
October 1, 2016.

For any questions, please call Medical Assistance Customer Services at 1-800-562-3022.

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.