Early refills and exceptions to Patient Review and Coordination assignments

Washington State Health Care Authority sent this bulletin at 03/13/2020 04:49 PM PDT

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Early refills and exceptions to Patient Review and Coordination assignments

In response to the COVID-19 outbreak, Health Care Authority (the Agency) is allowing early refills of medications. This applies to Apple Health Managed Care (MCO) and Fee-for-Service (FFS).

If a pharmacy claim rejects for refill-too-soon, re-submit the claim using the appropriate code or contact the listed Help Desk:

Apple Health Program	NCPDP vD.0 field	Code	Help Desk	Operating Hours
Amerigroup	420-DK Submission Clarification Code	13	1-833-253-4453	24/7 hours
Community Health Plan	420-DK Submission Clarification Code	13	1-800-922-1557	24/7 hours
Coordinated Care	420-DK Submission Clarification Code	13	1-800-364-6331	24/7 hours
Fee-For-Service	462-EV Prior Authorization Number	85000000911	1-800-562-3022	8:30am-4:30pm PST
Molina	420-DK Submission Clarification Code	13	1-800-364-6331	24/7 hours
United HealthCare	Overrides must be obtained by calling the Pharmacy Help Desk		1-888-306-3243	24/7 hours

For managed care clients enrolled in the Patient Review and Coordination (PRC) program needing prescriptions filled outside of their assigned pharmacy, please contact the client’s enrolled MCO.

For clients enrolled in FFS please call the PRC referral line during regular business hours (Monday-Friday, 8 a.m. – 5 p.m.) at Phone: 1-800-562-3022, ext. 15606 to request an override.

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.