School-Based Health Care Services (SBHS) Notification

Washington State Health Care Authority sent this bulletin at 03/23/2022 09:06 AM PDT

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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).

Questions?

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.

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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.