Chronic Opioid Attestation form—process update

Washington State Health Care Authority sent this bulletin at 12/04/2017 08:30 AM PST

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Chronic Opioid Attestation form—process update

Due to feedback and responses from the provider community, the Health Care Authority (HCA) updated the prescriber process for submitting the Chronic Opioid Attestation form (13-967) for Apple Health (Medicaid) fee-for-service clients.

If you previously submitted an attestation form for your patient and it was returned, follow the instructions below and resubmit the request.

Prescribers

To request authorization for your patient:

Complete and sign the Chronic Opioid Attestation form (13-967).
Fax the completed form to the pharmacy filling and dispensing the prescription.

Pharmacy billers

To submit a request once an opioid prescription and attestation has been received:

Bill the opioid prescription first.
Once a claim is submitted, complete the agency’s Pharmacy Information Authorization form (13-835A) as you would for any other authorization. This form must be typed and completed with all required fields.
As supporting documentation to the Pharmacy Information Authorization form (13-835A), attach the Chronic Opioid Attestation form (13-967) completed by the prescriber.
Fax both documents to HCA at: 866-668-1214. The Pharmacy Information Authorization form (13-835A) must be the first document in the fax transmission.

If the patient is out of medication and requires opioids that day, the pharmacy can use a one-time EA code 85000000542 for a known chronic opioid user to dispense a 7-day supply while the attestation form is being completed.

If the pharmacy has already used the one-time EA code but an authorization has not been approved due to attestation being previously returned, an additional 7-day supply may be dispensed using the EA code 85000000542 while the attestation is being resubmitted.

For clients in Apple Health managed care plans

Please contact your patient’s plan to request an authorization.

Phone numbers and authorization fax numbers by plan:

Amerigroup

Pharmacies: 1-844-367-6113
Providers (authorizations by phone): 1-800-454-3730
Providers (authorizations by fax): 1-800-359-5781

Apple Health Medicaid (fee-for-service)

Pharmacies: 1-800-562-3022 extension: 15483
Providers (authorizations by phone): 1-800-562-3022 extension: 15483
Providers (authorizations by fax): 1-866-668-1214

Coordinated Care

Pharmacies: 1-877-644-4613 Ext. 69622
Providers (authorizations by phone): 1-855-757-6565
Providers (authorizations by fax): 1-866-399-0929

Community Health Plan of Washington (CHPW)

Pharmacies: 1-800-922-1557
Providers (authorizations by phone): 1-844-605-8168
Providers (authorizations by fax): 1-877-251-5896

Molina

Pharmacies: 1- 800-213-5525 options 1,2,2
Providers (authorizations by phone): 1-800-213-5525 options 1,2,2
Providers (authorizations by fax): 1-800-869-7791

United Health Care

Pharmacies: 1-888-306-3243
Providers (authorizations by phone): 1-800-310-6826
Providers (authorizations by fax): 1-866-940-7328

For more information and resources regarding HCA’s Apple Health (Medicaid) opioid policy, visit the agency’s Opioid webpage.

About the Health Care Authority (HCA)

The Washington State Health Care Authority purchases health care for more than 2 million Washington residents through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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