Sexual and Reproductive Health Program (SRHP) enhanced rate, eff October 1, 2021

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Apple Health (Medicaid) Provider Alert

Effective for dates of service on and after October 1, 2021, the Health Care Authority (HCA) pays an enhanced rate to Apple Health contracted providers in the Department of Health’s (DOH) Sexual and Reproductive Health Program (SRHP) for designated procedure codes.

HCA updated the Family Planning Billing Guide, effective October 1, 2021, with billing instructions for SHRP providers. The agency is publishing the revised guides on the agency’s Provider Billing Guides and Fee Schedule page as soon as they are available. The SRHP Fee Schedule will also be published under the Family Planning section of the same webpage.

PLEASE NOTE: ProviderOne will not be ready with the rates on the SRHP Fee Schedule until close of business on October 15, 2021; however, SRHP providers must follow the SRHP fee schedule billing instructions for dates of service starting October 1, 2021. SRHP claims submitted to ProviderOne prior to October 15, 2021 will initially be paid at regular fee schedule rates, then HCA staff will adjust those claims to pay at SRHP fee schedule rates.