CORRECTION: Enrollment issue (previously labeled "Eligibility issue")

Washington State Health Care Authority sent this bulletin at 11/08/2024 05:07 PM PST

November 8, 2024

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Enrollment Issue

HCA is addressing an issue where clients, who should be enrolled in a Managed Care Organization (MCO), are mistakenly enrolled in a Medicare Savings Program (MSP). Although corrections made in ProviderOne system will reflect the client as active and enrolled in Managed Care, the MCO system or the MCO’s Prescription Drug Manager (PBM) may still indicate that the client is enrolled in Medicare.

If pharmacies encounter this discrepancy, they should verify the client’s eligibility in ProviderOne and then contact the client’s MCO to update the client’s eligibility. Alternatively, pharmacies can issue an emergency fill until the issue is resolved.

See the ProviderOne Billing and Resource Guide for direction on how to verify client eligibility

Contact

Contact HCA for questions

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

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.