CORRECTION to PROVIDERS: Health Care Authority coverage for telehealth services

Washington State Health Care Authority sent this bulletin at 03/06/2020 12:07 PM PST

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***You received the following notification today with an incorrect link to the Physician-Related Service/Health Care Professional Services Billing Guide. Please use this corrected version***

Health Care Authority (HCA) coverage for telehealth services

HCA reimburses providers for telemedicine services as related to RCW 74.09.325

Telehealth/telemedicine services provide an important and rapidly evolving suite of access tools for providers and patients for medical, dental and behavioral health services. The Washington Department of Health (DOH) and the Centers for Disease Control (CDC) are referencing the potential use of these tools as part of the state and national response required by the current coronavirus situation.

This document provides information about how to find policies and guidance for billing for telehealth services. It does not provide advice on how to deliver or receive health care or provide medical advice.

An example of a covered telemedicine service includes:

A client/patient calls a provider’s office to request an appointment due to respiratory symptoms and a fever. Instead of making an initial in-person appointment, the provider’s office could set up an appointment with the provider via telemedicine with the client at home. This is an eligible service and the provider could bill for reimbursement of the services.

Apple Health (Medicaid) clients

For Apple Health clients the provider would need to check client eligibility in ProviderOne to see which type of insurance coverage the client is eligible to receive. Instructions on navigating ProviderOne is in the ProviderOne Billing and Resource Guide on page 20.

Apple Health Program	Link to Policy/Payment Information	Customer service #
Fee For Service	Physician-Related Service/Health Care Professional Services Billing Guide	1-800-562-3022
Managed Care Organizations	Link to Policy/Payment Information	Customer service #
Molina	Molina Provider Guide	1-855-322-4082
United	Telemedicine Policy	1-877-542-9231
Amerigroup	Telemedicine FAQ	1-800-454-3730
Community Health Plan of WA	Telehealth Services	1-800-440-1561
Coordinated Care of WA	Covered Services Grid	1-877-644-4613

***This information is also available as a PDF

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care 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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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.