Apple Health (Medicaid): Provider Alert

Effective immediately, providers offering nonemergency ambulance transportation services are required to use expedited prior authorization (EPA) number 870001404 when submitting electronic claims for the following conditions: 

• Altered mental status (i.e. Alzheimer, dementia, or voluntary behavioral health services  –  not mental health services that fall under the Involuntary Treatment Act)
• Bedbound (not able to stand or bear weight unassisted)
• Quadriplegic
• Bariatric
• Continuous cardiac monitoring
• Requires a ventilator
• Requires continuous oxygen usage en route
• Tracheostomy (needed for prolonged respiratory support)

Additional information can be found in the Ambulance and ITA Transportation Billing Guide.

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.