Washington Apple Health is the name used in Washington State for Medicaid, the children's health insurance program (CHIP), and state-only funded health care programs. If you need an accommodation or require documents in another format, please call 1-800-562-3022. If you have any questions, call Provider Services at (855) 322-4082. Jan 31, 2020 · See the Health Care Authority's (HCA) Provider billing guides and fee schedules page to view all guides and fee schedules. Apr 1, 2022 · Use CPT® code 96127 or 96160, with up to two units per billing claim line. Washington Apple Health means the public health insurance Apr 13, 2023 · April 1, 2022 at June 30, 2022 — Audio hardware fee schedule (published March 30, 2022) July 1, 2021 go March 30, 2022 — Ear hardware fee schedule (published July 8, 2021) See all hearing hardware fee schedules; Social services (see appropriate fee schedule for rate) Social solutions addition (updated October 1, 2020) Prior authorization, claims, and billing | Washington State Health Care Authority. 00. Jul 19, 2023 · Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the Dental-related Services billing guide, Orthodontic Services billing guide, and Dental Program fee schedule that became effective July 1, 2023. Make sure to check the Updates & Corrections tab for any changes to the Fee schedules. See HCA's Zoom License Request page for May 12, 2023 · Yes. The agency’s fee schedule rate was set as of July 1, 2020, and is effective for services Apr 1, 2021 · Washington State Health Care Authority (HCA) Code Status Indicator Link to Legend * Please see the Physician-Related Services fee schedule D0120 D0140 D0150 D0160 Jan 1, 2020 · The Health Care Authority (agency) is committed to providing equal access to our services. Washington Apple Health means the public health insurance Title or Subject: Medicaid State Plan Amendment (SPA) 20-0023 July 2020 Fee Schedule Effective Date Updates Effective Date: July 1, 2020 Description: The Health Care Authority (HCA) intends to submit Medicaid State Plan Amendment (SPA) 20-0024 to update the fee schedule effective dates for several Medicaid programs and services. Dental Program Fee Schedule. Ongoing ACC Payment Reform Efforts. Step 2. Find an Apple Health dental provider or call 1-800-562-3022. Use CPT® code 96161 under the infant’s ProviderOne client ID. Caregivers of infants age 6 months and younger must be screened for depression. Effective July 1, 2021. Note: Make sure to check the Updates & Corrections tab for any changes to the Payment policies. See 42 CFR § 419. The Health Care Authority is committed to providing equal access to our services. g. This is a Use the resources on this page to manage your practice’s billing, or see our Provider Manual for more information. Coverage and billing guidelines found in this billing guide apply to both MCO clients and FFS clients. May 1, 2020 · The Health Care Authority (agency) is committed to providing equal access to our services. Sep 1, 2023 · Physician Fee Schedule. Login to Secure Access Washington (SAW). In addition to the ProviderOne Billing and Resource Guide, you will find: User manuals Fact sheets Webinars Rates, fee schedules, and provider billing guides Rates and fee schedules provide you with the codes and allowable amounts for Notice: January 2023 Fee Schedule Update Medicaid State Plan Amendment 23-0006 Public Notice is now available online. October 14, 2022 Inpatient Hospital Services Billing Guide. Mobile app: Download the in” or “create an account”. pdf. Step 1: Check client eligibility Log into ProviderOne to determine if your client is eligible for the service (s) or treatment (s) you wish to provide. 20 and younger to detect physical and behavioral health problems. askmedicaid@hca. WAPlanfinder app – select “sign. Service. CPT® codes and descriptions only are copyright 2020 American Medical Association. A completed Outpatient Rehabilitation Authorization Request form, HCA 13-786, and all the documentation listed on this form and any other medical justification is required for an LE. Map / Directions Feb 1, 2022 · About this guide*. January 2023 Fee Schedule Update Medicaid State Plan Amendment 23-0006 Public Notice | Washington State Health Care Authority Feb 14, 2024 · Home care aides and nursing assistant-certified alternative training timelines: Worker hired or rehired during the time frame of: Must complete basic training no later than: Must be certified as a HCA or CNA no later than: Worker hired or rehired during the time frame of: August 17, 2019 to September 30, 2020. Use the links below to download the Fee Schedule in your desired file format. Learn how using our Successful eligibility checks using ProviderOne fact sheet. The HCA may not proceed with a carved-out or carved-in managed care dental option at this time. • Be a Washington state resident, as described in WAC 182-503-0520 • Have an income at or below 260% of the federal poverty level, as described in WAC 182-505-0100 • Need family planning services. • Phone: Call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633 or 855-627-9604 (TTY). About the guide The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: Rates and program information for hospitals serving Medicaid clients using the Washington State Medicaid Prospective Payment System (PPS fee-for-service). bui@hca. Washington State Medical Association website: COVID-19 and Telehealth . All of the changes that have been made are listed at the beginning of the billing guides Jan 1, 2024 · For patients age 65 and older or on Medicare, go to Washington Connections – select the “Apply Now” button. To learn more about the toolkit, visit the HCA website. Fax the forms and all documentation to: 866-668-1214. These fee schedule updates are budget neutral and are not anticipated to have an effect on providers’ annual expenditures. To learn more about using ProviderOne to file your claims, use our ProviderOne resources section. Medical_Fee_Schedule. Jan 4, 2022 · Attention Medicaid Providers: The Washington State Health Care Authority (HCA) published January 1 updates to the following Apple Health Billing Guides as well as the Dental program fee schedule: Access to Baby and Child Dentistry/Mouth Matters Billing Guide. For questions email: applehealth. Feb 1, 2022 · About this guide*. For the latest trainings and resources on integrated care and other best practices please click here. What you pay after reaching deductible. Apple Health (Medicaid) Transhealth program Primary care, behavioral health Jul 1, 2022 · Use CPT® code 96127 or 96160, with up to two units per billing claim line. This publication takes effect January 1, 2024, and supersedes earlier billing guides to this program. On March 9, 2024, President Biden signed the Consolidated Appropriations Act, 2024, which included a 2. Unless otherwise specified, the program(s) in this guide is governed by the rules found in WAC 182-531-1675. 93 percent update to the CY 2024 Physician Fee Schedule (PFS) Conversion Factor (CF) for dates of service March 9 through December 31, 2024. The provider must justify that the request is medically necessary (as defined in WAC 182-500-0070) for that client. Estimated fees. Store and forward technology – Use of an asynchronous transmission of a covered person's medical or behavioral health information from an Jun 3, 2024 · For the official and definitive CMS PFS payment files, contact your MAC. Verify the patient’s eligibility for Apple Health. Kaiser Permanente calculates allowable reimbursement at the lower of charges or the maximum amount allowable on the pertinent Kaiser Permanente Washington provider reimbursement schedule described below. Title SPA packet number Date approved Pharmacy Average Sales Price 23-0002 9/19/2023 January 2023 fee schedule updates 23-0006 3/15/2023. Unless otherwise specified, the program in this guide is governed by the rules found in WAC 182-556-0200. Oct 1, 2023 · The Health Care Authority is committed to providing equal access to our services. Jan 1, 2022 · The Health Care Authority is committed to providing equal access to our services. This publication takes effect February 1, 2022, and supersedes earlier billing guides to this program. PA H2020 Ther behav svc, per diem Per Diem 0373T 0509 UN Step-by-step guide for prior authorization | Washington State Health Care Authority. HCA's Physician Related Services Billing Guide; HCA's Emergency Covid-19 Fee Schedule; In response to the COVID-19 pandemic, the HCA has purchased a limited number of licenses for Zoom, a video conferencing technology that helps health care providers continue seeing patients without a physical encounter. C. People who have hearing or speech disabilities, call 711 for relay services. Feb 1, 2024 · The Health Care Authority is committed to providing equal access to our services. Apr 1, 2022 · The Health Care Authority is committed to providing equal access to our services. Jan 1, 2024 · About this guide*. Please note that you can submit electronic or paper claims. We're continually adding new features to increase efficiency, giving you more time to support your patients. Check the information your health plan sent you to see how to make your first appointment. HCA requires hospitals to bill interim claims, using the appropriate patient status code for “still inpatient,” in 60-day intervals unless the client is discharged prior to the next 60 days. (Place of service 11) When you submit a claim submit your usual fee. The fees are effective for dates of service March 9, 2024 through December 31, 2024. CHPW accepts electronic claims via the Availity Clearinghouse. Providers must bill with modifier PO when it is appropriate. The carrier or MAC processes your claim based on the place of service you select. ProviderOne You file all claims through the ProviderOne portal. PO/PN modifiers. The CY 2024 MPFS fees posted are valid from January 1, 2024 through March 8, 2024. Physicians . Please do not post private or sensitive information such as names, addresses, phone numbers, emails, confidential financial and legal details. As our partner, assisting you is one of our highest priorities. Read about the highlights of changes in the last year. Use procedure code 96161 under the infant’s ProviderOne client ID. Unless otherwise specified, the program(s) in this guide are governed by the rules found in. Oct 1, 2020 · About this guide*. Washington Apple Health is administered by the Washington State Health Care Authority. Step 3: There are two login steps in order to renew online: 1. Comma Separated Values. Adobe Portable Document Format. File. Description. Sep 15, 2021 · September 15, 2021. wa. Aug 1, 2022 · The Health Care Authority evaluates requests for authorization of covered outpatient rehabilitation services that exceed limitations in this billing guide on a case-by-case basis in accordance with WAC 182-501 0169. Effective October 1, the Washington state Health Care Authority (HCA) will increase the Medicaid professional fee schedule amounts for designated behavioral health, primary care, and pediatric critical care services. WAC 246-324-990 Fees. For additional information, contact: Name: Jean Bui Program: Rates Development Address: 626 Ave SE, Olympia, WA 98501 Phone: 360-725-1973 TDD/TTY: 800-848-5429 Fax: 253-350-6512 E-mail address: jean. Copay or coinsurance (e. Phone: Call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633 or 855-627-9604 (TTY). When billing procedure code 96161 for a fee-for-service (FFS) client, use EPA # 870001424. This publication takes effect October 1, 2020, and supersedes earlier billing guides to this program. What is the 340B Drug Pricing Program? The 340B Drug Pricing Program is a federal program created in 1992 for section 340B (a) (4) of the Public Health Service Act (PHSA). The AMA does not directly or indirectly practice medicine or dispense medical services. Dental-related Services Program Billing Guide. The new payment amounts reflect 15 percent increases for a range of behavioral health and adult primary care Find a dental provider. This rate is higher because the physician practice has overhead expenses for performing that service. See information about adopted fee increases (PDF). Sign up for Cigna for Health Care Providers: a hcp portal login which provides the information Oct 1, 2020 · The Health Care Authority is committed to providing equal access to our services. Paid amounts shall reflect the maximum allowable Apr 1, 2022 · Outpatient service providers must report the service facility location for off-campus, outpatient, provider-based departments of hospital facilities. You must have an appointment to see a provider. 2023 | Washington State Health Care Authority. See 4. The 2019 Legislature has directed the Washington State Health Care Authority (HCA) to continue to administer the dental Medicaid program through fee-for-service. Washington Apple Health means the public health insurance programs for Oct 14, 2022 · Washington Apple Health (Medicaid) Physician-Related Services/Health Care Professional Services . Orthodontic Services Program Billing Guide. What you pay before reaching deductible. Jan 1, 2023 · The Health Care Authority is committed to providing equal access to our services. See WAC 182-550-6000 (3)(c). Washington Apple Health means the public health insurance programs for . Make sure to check the Updates & Corrections tab for any changes to the Payment Policies or Fee Schedules. Check claims, payments, and fee schedules. 48 – for a description of excepted items and services. WAC 182-500-0070. Interim billing. Washington, DC 20037; Contact Member Care; Phone: 1-202-375-6000; Toll Free: 1-800-253-4636; Jan 1, 2024 · The Health Care Authority evaluates requests for authorization of covered outpatient rehabilitation services that exceed limitations in this billing guide on a case-by-case basis in accordance with WAC 182-501 0169. Visit DentistLink or call 1-844-888-5465. Washington Apple Health means the public health insurance Feb 23, 2022 · Washington State Hospital Association 999 Third Avenue Suite 1400 Seattle, WA 98104. October 2022 Fee Schedule Effective Dates Medicaid State Plan Amendment 22-0033 Public Notice | Washington State Health Care Authority Jan 9, 2024 · Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the Dental Program Fee Schedule , Dental-related Services billing guide and Orthodontic Services billing guide. Aug 1, 2022 · Related outpatient hospital services, including pre-admission, emergency room, and observation services related to an inpatient hospital stay and provided within one calendar day of a client hospital stay, must be billed on the inpatient hospital claim. More information is available in our Provider Manual, or you can contact Availity at (800) 282-4548. Notice: October 2033 Fee Schedule Effective Dates Medicaid State Plan Amendment 22-0033 Public Notice now available online. STATE OF WASHINGTON HEALTH CARE AUTHORITY 626 8th Avenue, SE • Olympia, Washington 98501 March 23, 2023 NOTICE Title or Subject: Medicaid State Plan Amendment (SPA) 23-0021 April 2023 Fee Schedule Updates Effective Date: April 1, 2023 Description: The Health Care Authority intends to submit Medicaid State Plan Amendment (SPA) 23- Jan 1, 2017 · Washington residents. October 1, 2021. We welcome your feedback and look forward to supporting all your efforts to provide quality care. Questions and comments are moderated. Jul 1, 2023 · Step 1. The program requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at Jan 1, 2021 · 29 | FAMILY PLANNING BILLING GUIDE. The purpose of this program is to periodically screen clients age. The Agency also used dental definitions found in the current American Dental Association’s Current Dental Terminology (CDT) and the current American Medical Association’s Physician’s Current Procedural Terminology. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a federally mandated preventive health care benefit. Medicaid scope of coverage for physician-related and health care professional services: WAC 182-531-0100. gov Jul 1, 2021 · ABA Treatment Fee Schedule Rev code Maximum Allowable Fee Brief Description Functional Assessment and Analysis and Treatment Plan Development 0362T Team Conference * 30 min. Physician reimbursement for medical (non-psychiatric), surgical, and anesthesia services. Oct 1, 2023 · Washington State Confidentiality Toolkit for Providers is a resource for providers required to comply with health care privacy laws. Jul 1, 2022 · The Department is allowing coverage of the COVID-19 booster vaccine (code 0044A) for immunocompromised workers who reside in a nursing home, group home, or skilled nursing facility, or receiving home health at home. The Health Care Authority (HCA) is committed to providing equal access to our services. MCOs to pay no less than the FFS fee schedule Sec 211(51) Developmental Screening January 2024 100% : MCOs to pay no less than the FFS fee schedule NA 3 Home and Birthing Center . Clinical Lab Fee Schedule. OverviewWhat's the PFS Look-Up Tool?The PFS Look-Up Tool gives Medicare payment information on more than 10,000 services, including:PricingAssociated relative value units (RVUs)Payment policiesThe tool doesn’t display Medicare Administrative Contractor (MAC) priced codes Apr 1, 2023 · For patients age 65 and older, or on Medicare, go to Washington Connections – select the “Apply Now” button. transhealth@hca. The Health Care Authority offers durable medical equipment and supplies for Apple Health (Medicaid) eligible clients. model guidelines— Core principles In the Jan 1, 2022 · Washington State Health Care Authority This site contains the policies, payment methods and maximum fees used to pay health care and vocational providers who treat injured workers and crime victims. Find information about dental services covered under Washington Apple Health (Medicaid). January 2024 : $2,500 for Birthing Center Facility Fee, $500 for kit MCOs to pay no less than the FFS Apr 1, 2021 · Use procedure code 96127 or 96160, with up to two units per billing claim line. About this guide. Use the following Fee Schedules and Payment Policies by year: 2024 Fee Jan 1, 2021 · The Health Care Authority is committed to providing equal access to our services. – The Washington State Health Care Authority. People who have hearing or speech disabilities, please call 711 for relay services. If the patient is eligible for Apple Health, proceed to Step 2. HCA created this new guide to make policy and billing information for the Transhealth Program easier to access for providers. The changes to the Dental-related Services billing guide and fee schedule are effective January 1, 2024, and the changes to fee schedule Sec 211(49) Lower-level BH (non-BHA) January 2024 7% . The maximum fee for this code is $40. Jul 1, 2023 · Effective July 1, 2023. chapter 182-553 WAC. Jul 1, 2023 · Title: EPSDT fee schedule effective July 1, 2023 Author: WA State Health Care Authority Last modified by: Slakey, Stefanie (HCA) Created Date: 1/29/2018 9:30:16 PM Jan 1, 2021 · Use procedure code 96127 or 96160, with up to two units per billing claim line. * This publication is a billing instruction. All questions and comments are moderated and publicly viewable. $80. You should be able to find the provider's office contact information through your health plan's website. Medically necessary – See . May 30, 2024 · The CY 2024 Medicare Physicians Fee Schedule has been updated due to The Consolidated Appropriations Act, 2024. Fee Schedule Updates. Notice: January 2022 Fee Schedule Updates Medicaid State Plan Amendment 22-0009 Public Notice is now available online January 2022 Fee Schedule Updates Medicaid State Plan Amendment 22-0009 Public Notice | Washington State Health Care Authority Jan 1, 2022 · The Health Care Authority is committed to providing equal access to our services. 2. Ambulance services provided to clients who are enrolled in an HCA-contracted managed care organization (MCO) are paid by HCA through fee-for-service (FFS). Aug 1, 2022 · Step 1. This site contains the policies, payment methods, billing codes, and maximum fees used to pay health care and vocational providers who treat injured workers. 19-B I, General, #G for the agency’s website where the fee schedules are published. These billing and payment policies determine under what conditions we will pay health care and vocational providers who treat injured workers and crime victims. Except as otherwise noted in the plan, fee schedule rates are the same for both governmental and private providers of dentures, dental services and dental hygiene. Once you have selected a PCP, call their office to make an appointment. or more. Apple Health eligibility manual overview; Introduction overview for general eligibility; General eligibility requirements that apply to all Apple Health programs Apr 5, 2021 · Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the following Apple Health Billing Guides as well as the Dental program fee schedule: Dental-Related Services Program Billing Guide. Washington is a member of the Physical Therapy Compact. For detailed instructions on verifying a patient’s eligibility for Apple Health, see the Client Eligibility, Benefit Packages, and Coverage Limits section in HCA’s ProviderOne Billing and Resource Guide. WAPlanfinder app – select “sign in”. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. This publication takes effect. Contact Consolidated Technology Services (24 hours) at 855-928-3241 or email them if you experience problems with the SAW website. *See billing guide Telemedicine Q3014 Telehealth originating site facility fee Per completed transmission. Oct 1, 2021 · If this is the most recent guide, please notify us at. Feb 22, 2024 · The non-facility rate is the payment rate for services performed in the office. • Mobile app: Download the or “create an account”. csv. Jan 1, 2023 · Physician-Related Services/Healthcare Professional Services Billing Guide. Prior authorization is required. Dental_Fee_Schedule. 182-502-0006: Collaborative care . X-ray of knee. Effective October 19, 2022. Fee Schedule Download. gov. May 1, 2018 · Washington residents. Login to the Department of Health HSQA Online Services after logging into SAW. Jan 1, 2021 · Use procedure code 96127 or 96160, with up to two units per billing claim line. Aug 1, 2022 · Outpatient service providers must report the service facility location for off-campus, outpatient, provider-based departments of hospital facilities. Full charges: $80. Ambulance providers must bill HCA directly. 1 This publication is a billing instruction. If you need an accommodation or require documents in another format, call 1-800-562-3022. , $10 or 20% of estimated fee) Ultrasound of pelvis. Email: HCAWA340BRebate@hca. Make an appointment. Jan 1, 2021 · See the Health Care Authority’s prior authorization webpage for details. The AMA assumes no liability for data contained or not contained herein. Explore all provider resources. Originating site – The physical location of a client receiving health care services through telemedicine. Below are definitions of words and phrases that the Health Care Authority (the Agency) uses in this Medicaid provider guide. Billing Specific to Hospital Services. The following fee schedules will now be effective April 1st through March 31st starting in calendar year (CY) 2019: Physician's (RBRVS) Fee Schedule. Services, equipment, or both, related to any of the programs listed below must Jan 1, 2020 · Title 42 CFR, Part 441, Subpart B. Update your Cigna Healthcare SM provider directory information. If you have any questions, please contact Leigh Ann Moore (OAMR) at 304-356-4916. When billing CPT® code 96161 for a fee-for-service (FFS) client, use EPA # 870001424. Minimum of 10 characters. Find an Apple Health dental provider for children (InsureKidsNow). STATE OF WASHINGTON HEALTH CARE AUTHORITY 626 8th Avenue, SE • Olympia, Washington 98501 September 15, 2021 NOTICE Title or Subject: Medicaid State Plan Amendment (SPA) 21-0034 October 2021 Fee Schedule Effective Date Updates Effective Date::October 1, 2021 Apr 1, 2023 · physician-related services? In the final bullet of the list of healthcare professionals, changed “licensed by the State of Washington DOH” to “licensed according to Washington state law” To comply with WAC . Jul 1, 2021 · 2021 Fee Schedules. If you applied for health coverage through the Department of Social and Health Services or Washington Connection, you must report this change by either calling 1-877-501-2233 or online at Washington Connection. Washington is a member of the Interstate Medical Licensure Compact. Payment Policies Complete (2023) Oct 1, 2020 · Use procedure code 96127 or 96160, with up to two units per billing claim line. , and supersedes earlier billing guides to this program. Caregivers of infants age six months and younger must be screened for depression. xd ll sc ec gj yk pb ol tv el