School-Based Health Care Services (SBHS) Notification

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School-Based Health Care Services (SBHS) notification

March 23, 2022

SBHS claim denials

Some SBHS claims are posting edit code 02190 in error. This may cause some SBHS claims to deny incorrectly. These claims can be identified on the ProviderOne weekly remittance advice (RA) with rejection code "204: This service/equipment/drug is not covered under the patient's current benefit plan". 

HCA continues to research this issue. SBHS-contracted self-billing school districts and billing agents should continue to submit claims per their usual process. If claims deny with rejection code 204, HCA will automatically reprocess the claims which means the district or billing agent does not need to resubmit the denied claims. Claims that have been resubmitted by HCA will show up on the weekly RA with a transaction control number (TCN) that begins with the number "4" (for example 4022049xxxxxx).


Any questions about this issue may be emailed to the SBHS program manager. Thank you for your patience and understanding as we look into this issue!

*Please note this bulletin is strictly related to SBHS program claims (IEP/IFSP services) and is not related to managed care claims and/or school-based health center/clinic claims.


About the SBHS program

The Washington State School-Based Health Care Services (SBHS) program is administered by the Health Care Authority (HCA). School districts participating in the SBHS program may receive reimbursement for providing health care-related services to Title XIX Medicaid-eligible students with Individualized Education Programs (IEPs) or Individualized Family Service Plans (IFSPs). Visit the SBHS webpage for more information.

Please feel free to share SBHS news with your colleagues!

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