Amerigroup Washington, Inc. is closely monitoring COVID-19 developments and how they will impact our customers and our health care provider partners. Important: Inadvertently approved authorizations do not guarantee claims payment. Refer to the Prior Approval Drugs and Criteria page for specific criteria. To view a list of qualifying services, download our EPA inventory. See the self-service training resources below: Complete the General Information for Authorization form (13-835) with all supporting documentation and fax it to: 1-866-668-1214. The Health Care Authority’s (HCA) authorization services do not consider National Correct Coding Initiative (NCCI) guidelines when processing a request. Use our provider billing guides and fee schedules to review policy and find out whether a code or service requires prior authorization. See whether a PA is required for that place of service. Place in a larger envelope for mailing. The agency may recoup any payment made to a provider if the provider did not follow the required EPA process and if not all of the specified criteria were met. Log into ProviderOne to determine if your client is eligible for the service(s) or treatment(s) you wish to provide. 719A Prior Authorization Request Form; DC Nursing Facility Cost Report Form; DC Specialty Hosp FAQ Eff 10/1/2019 DCS19004; DC APR-DRG FAQ Eff 10/1/2019 DCI19005; Consent For Sterilization - Spanish - HHS 687-1 Hospice Discharge Form; Level 1 Pre-Admission Screen/Resident Review (PASRR) for SMI, ID, or Related Conditions; DC Alliance Formulary List For example: Check the physician fee schedule and the ambulatory surgery center (ASC) fee schedule if you are performing the service in an ASC to: The following is a shortened list of regularly used billing guides and fee schedules. Providers now have the ability to retrieve their correspondence in ProviderOne. Claims submitted without valid Medicaid ID will be rejected and are not payable. Do not include a fax coversheet. Prior to sending your requests, please be sure that eligibility is checked. Molina Healthcare of Washington Phone: (800) 213-5525 Option 1-2-2 | Fax: (800) 869-7791 Urgent . Phone: (800) 562-3022 ext. 15483. These services are subject to postpayment review and audit by the agency or its designee. The status of a prior authorization request may be checked online at the www.idmedicaid.com under “Authorization Status”, using your NPI, or by contacting DXC at (866) 686-4272. This form may contain multiple pages. Learn more about your customer service options. Prior Authorization Requirements for Washington Medicaid Effective July 1, 2019 General Information . Put the client’s name, ProviderOne ID#, and service type the request is for on the envelope. UHCprovider.com. Prior Authorization Review is the process of reviewing certain medical, surgical, and behavioral health services according to established criteria or guidelines. This list contains prior authorization requirements for care providers who participate with UnitedHealthcare Community Plan in Washington for inpatient and outpatient services. Community Health Plan of Washington (CHPW) covers many treatments and services. Use one of the following two options when you fax or mail your submissions: Note: When this option is chosen, fax your request to the agency and indicate the NEA# in the NEA field on the PA request form. The recommended method for submitting a PA request is to key it directly into the secure NCTracks provider portal. Phone Number: (800) 869-7185. Washington Medicaid-Approved Preferred Drug List. Q4186 is a covered benefit and require a prior authorization for all providers. Reauthorization ... (I certify that all of the information on this form is true and accurate to the best of my knowledge) X . Fax Number: (800) 767-7188. Complete the General Information for Authorization form (13-835) with all supporting documentation and mail it to: Authorization Services Office Providers are now required to enter the client's first and last name for online submission requests. For a complete list, visit our Provider billing guides and fee schedules webpage. QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month Please ensure that when submitting a prior authorization request that the required documentation is included along with a fax number. Kaiser Permanente Washington frequently requested forms including medical record release, prescription transfer, address change, and claims. The Washington Medicaid prior authorization form is used by medical practitioners in Washington State when they need to request Medicaid coverage for a non-preferred medication. Willamette Dental Group of Washington, Inc. 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