Apple Health (Medicaid): Provider Alert

The Health Care Authority has published an updated Enteral Nutrition Billing Guide, effective May 1, 2017.

Changes include a complete reorganization of the guide; several new forms replacing previous forms, including a new prescription form; new requirements for prescribing providers, dietitians, and dispensing providers, particularly related to oral enteral nutrition; and discontinued expedited prior authorization (EPA) numbers.

Major changes include:

• A new section on thickeners, including:
• New forms for thickeners
• New EPA #870001406 for clients age one through 20
  
  
•  A new section on inherited metabolic disorders, including:
• New forms for formulas
• New EPA #870001405 for clients age 20 and younger
• New Exception to Rule (ETR) form for clients age 21 and older
  
  

• A new section on tube-delivered enteral nutrition.

• A new section on enteral equipment and related supplies, including a new form. 
• A new section on oral enteral nutrition (please read the new section thoroughly for details), including:
• New EPA #870001407 for an immediate one-time, one-month supply of oral enteral nutrition product for clients age 20 and younger when the client has an urgent need
• New EPA #870001408 covers a monthly supply for up to 6 months for clients age 20 and younger when certain criteria are met
• New prior authorization requirement for all clients requesting oral enteral nutrition products for more than 6 months

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.

Please do not reply directly to this message. If you have feedback or questions, please visit the HCA website for contact information.