IHCP managed care billing escalations

Washington State Health Care Authority sent this bulletin at 07/21/2023 10:30 AM PDT

July 21, 2023

IHCP managed care billing escalations

Indian Health Care Providers (IHCPs) provide much needed services to Native communities throughout the State of Washington. We understand that due to the unique relationship between the State Medicaid program and federal Indian Health Service (IHS) that billing challenges, claims denials, and contract concerns with Managed Care Organizations (MCOs) can arise.

The Health Care Authority (HCA) would like to provide clarity and awareness regarding the pathway for resolving these types of issues. The purpose of this process is to ensure that each escalation is accurately triaged, tracked, and addressed separately and in a timely manner.

Roadmap to resolution

Reach out to the Managed Care Plan (MCO) tribal liaison. There are specific contacts within each MCO that are dedicated to this work. See the current contact list.
If no response is received from the MCO, the escalation should then be forwarded to HCA’s Managed Care team at hcamcprograms@hca.wa.gov. The issue will be tagged with an HCA issue number for tracking and triaged to the correct contract manager for assignment and follow up.
The contract manager will ensure the issue is tracked and total resolution is reached. During this process, close communication with the plan and provider are required.
To support this effort and recognizing nuances that can occur with each billing issue, all follow-up communications must include the designated HCA issue number. Each escalation requires a new HCA issue number for tracking.
MCOs should respond to IHCP inquiries/escalations within 3-5 business days.

Contact

If you have any questions or concerns regarding this process, contact the managed care team at hcamcprograms@hca.wa.gov.

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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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.