Provider Notices 2013

Emails relevant to rules, Medicaid provider guides, and policies

Notice number Subject Issue date Effective date
13-119 Revised patient eligibility verification instructions now available in Medicaid Provider Guides 12/31/13 01/01/14
13-118 Kidney Center Service coverage requirements for selected procedure codes 12/24/13 01/01/14
13-117 Hemophilia and von Willebrand-related products must be billed fee-for-service 12/24/13 01/01/14
13-116 Therapy, School, Medical supplies, Hospice-Home health, Nursing homes, Fqhcs-Rhcs: PN 13-116 New Service Category: Habilitative Services 12/31/13 01/01/14
13-115 Family services, Clinicians, Managed care: PN 13-115 Sterilization Medicaid Provider Guide 12/31/13 01/01/14
13-114 School: School Based Health Care Services: Provider enrollment requirements and code changes 12/31/13 01/01/14
13-113 Clearing houses, Medical supplies, Managed care, Tribal: New Complex Rehabilitation Technology Medicaid Provider Guide 12/30/13 01/01/14
13-112 Pharmacy, Managed care: Hemophilia and von Willebrand-related products for all eligible Medicaid clients 12/20/13 Superseded
(see 13-117)
01/01/14
13-111 Pharmacy, Managed care: Mental health medications prescribed to Managed Care Organizations (MCO) clients. 10/11/13 01/01/14
13-110 Hospitals, Managed care: Zostavax vaccine reimbursed through fee-for-service (FFS) for Medicaid clients 60 years of age and older. 10/11/13 01/01/14
13-109 Pharmacy, Managed care: Hemophilia and von Willebrand-related products for all eligible Medicaid clients 10/11/13 Superseded
(see 13-112)
01/01/14
13-108 Pharmacy, Managed care: Agency requirement to dispense contraceptives as a 12 month supply. - Prescribers. 10/08/13 01/01/14
13-107 Pharmacy, Managed care: Agency requirement dispense contraceptives as a 12-month supply. - Pharmacy 09/30/13 01/01/14
13-106 Prosthetic and Orthotic and Wheelchairs DME MPGs and Fee Schedule Update 12/31/13 01/01/14
13-105 Vision-hearing, Managed care : Update the Vision Hardware for Clients 20 years of Age and Younger Medicaid Provider Guide to add Billing for Ocular Prosthetics 12/27/13 01/01/14
13-103 Respiratory Care Medicaid Provider Guide Coverage Update 12/31/13 01/01/14
13-102 Planned Home Births update coverage and screening panels for newborns 12/26/13 01/01/14
13-101 Therapy, Clinicians, Managed care: Neurodevelopmental Centers 12/31/13 01/01/14
13-100 Outpatient Prospective Payment System (OPPS) and Outpatient Hospital Fee Schedule Update 12/31/13 01/01/14
       
13-98 Mh-Rsns, Hospitals, Clinicians, Managed care: New policies to achieve mental health parity in benefits 12/31/13 01/01/14
13-97 Hospitals, Managed care: Kidney Center Service coverage requirements for selected procedure codes 09/24/13 Superseded
(see 13-118)
01/01/14
13-93 Hospice-Home health, Medical supplies, Managed care, Nursing homes, Pharmacy: Home Health coverage and fees for selected procedure codes 12/31/13 01/01/14
13-92 Clinicians, Managed care: HIV/AIDS Case Management: Updated Statement of Purpose 12/31/13 01/01/14
13-90 Family services, Clinicians, Managed care: Family Planning: updated TAKE CHARGE eligibility criteria; clarified delayed pelvic protocol 12/31/13 01/01/14
13-89 Managed care: Update Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Medicaid Provider Guide EPSDT exams 12/27/13 01/01/14
13-88 Enteral Nutrition update coverage and fees for selected procedure codes 12/26/13 01/01/14
13-87 ASC Fee Schedule updates 12/31/13 01/01/14
13-86 Not issued    
13-85 Multiple procedure payment reduction (MPPR) payment model for multiple diagnostic radiology procedures 12/23/13 01/01/14
13-84 Physician-Related Services/Health Care Professional Services - January 1, 2014 Updates 12/20/13 01/01/14
13-83 Dental-Related Services - Restoration of Adult Dental Benefit 12/20/13 01/01/14
13-82 Pharmacy, Managed Care : Prescription Drug Maximum Allowable Costs Update 12/03/13 01/01/14
13-81 IHS encounter rate increase
Supersedes PN 13-35
11/25/13 01/01/13
13-79 Reminder for all providers of the NCCI requirement regarding add-on codes on claims 11/20/13 11/20/13
13-78 Clinicians, Family Services, Managed Care, Pharmacy, School, Tribal: Injectable Drugs fee schedule update 11/15/13 11/15/13
13-77 Pharmacy, Managed Care: Washington Preferred Drug List update 11/13/13 12/01/13
13-76 Pharmacy, Managed care: Prescription Drug Maximum Allowable Costs Update 10/29/13 12/01/13
13-75 Clearinghouses, Clinicians, Vision-Hearing, Managed Care, Tribal: Hearing Hardware for Clients 20 and Younger – adding coverage for batteries; removing coverage for FM systems. 10/29/13 11/01/13
13-74 All: Provider revalidation process starting in December 2013 10/24/13 12/01/13
13-73 Hospitals, Managed care: Outpatient Prospective Payment System (OPPS) and Outpatient Hospitals (OPPS) fee schedule update 10/29/13 10/01/13
13-72 Pharmacy, MH-Rsns, Managedcare,Familysvcs: Alpha Agonist requirement for 17 years of age and younger 11/25/13 02/01/14
Superseded
(see 14-11)
13-71 Hospitals, Managed care: Outpatient Prospective Payment System (OPPS) Fee Schedule and Outpatient Services MPG 10/11/13 10/01/13
13-70 Clinicians, Mental Health, Managed care: Update billing information Psychological Testing in Agency-designated Autism Centers of Excellence 10/11/13 10/01/13
13-69 Pharmacy, Managed care: Maximum allowable cost update 10/01/13 10/01/13
13-68 Pharmacy, Managed care: 30 day pre-release of the agency’s Expedited Authorization List 10/08/13 11/01/13
13-67 All : EPSDT Clarify and update the requirements for the administration and the criteria for the authorization of Synagis 10/17/13 11/01/13
13-66 Clinicians, Mental Health, Managed care: Update billing information Psychological Testing in Agency-designated Autism Centers of Excellence 09/30/13 Superseded
(see 13-70)
13-65 Hospice, Home health, Medical Supplies, Managed Care, Nursing Homes, Pharmacy: Update the Enteral Nutrition Fee Schedule 09/26/13 10/01/13
13-64 Hospice, Home Health : Update the Hospice Fee schedule and the Hospice Services Medicaid Provider Guide 10/01/13 10/01/13
13-63 Hospice, Home Health, Managed care: Update HCPCS and revenue codes for home health services through telemedicine. 09/30/13 10/01/13
13-62 Hospitals, Managed care: Update Outpatient Prospective Payment System (OPPS) Fee Schedule and Outpatient Services MPG 09/24/13 Superseded
(see 13-71)
13-61 Medical Supplies, Managed Care: Update prior authorization requirements for HCPCS code A4466 10/01/13 Retroactive to 7/01/13
13-60 Pharmacy, Managed Care: Washington Preferred Drug List update 09/30/13 10/01/13
13-59 Pharmacy, Managed Care: October Drug Maximum Allowable Costs Update. 09/03/13 10/01/13
13-58 Clinicians, Family Services, FQHC, Hospitals, Managed Care: Updated the Family Planning fee schedule to coincide with recent changes to the Family Planning Medicaid Provider Guide (MPG) and Chapter 182-532 WAC. 09/16/13 Retroactive to 09/01/13
13-57 Pharmacy, Managed Care: The Medicaid Program of the Health Care Authority (agency) will no longer require prior authorization for Rectiv® (nitroglycerin) and will add it to the expedited authorization (EA) list. 09/03/13 09/01/13
13-56 Clearinghouses, Clinicians, FQHCs-RHCs, Family Services, Hospitals, Managed care, Labs-Radiology, Pharmacy, Therapy, Transportation, Tribal: Physician Related Services MPG 09/30/13 10/01/13
13-55 Pharmacy, Managed Care: Prescription Drug update descriptions for selected CPT® procedure codes. 08/20/13 08/19/13
13-54 Pharmacy, Managed care: Maximum allowable costs update 08/01/13 09/01/13
13-53 Pharmacy, Medical Supplies, Managed Care: Wheelchair and DME Coverage Table updates 08/02/13 Retroactive to 07/01/13
13-51 Clinicians, Family Services, FQHC, Hospitals, Managed Care: Updating and clarifying reproductive health services, family planning only, TAKE CHARGE, and sterilization information to reflect rule changes in Chapter 182-532 WAC and WAC 182-182-531-1550. (See WSR 13-16-008.) 08/28/13 09/01/13
13-50 Hospitals, Managed care: Outpatient Prospective Payment System and Outpatient Hospital Fee Schedule 08/01/13 Retroactive to 07/01/13
13-49 Transportation, Managed: Update of the Ambulance ITA Medicaid Provider Guide 09/09/13 Retroactive to 09/01/13
13-48 Pharmacy, Managed Care: Prescription Drug Maximum Allowable Cost Update 06/27/13 08/01/13
13-47 Hospitals, Managed Care: Outpatient Hospital Fee Schedule - Update coverage and prior authorization requirements for selected procedure codes 06/26/13 07/01/13
13-46 Pharmacy, Med Supplies, Managed Care: Nondurable Medical Supplies and Equipment and Prosthetic and Orthotic Devices Medicaid Provider Guides 06/27/13 07/01/13
13-45 All: Updated fee schedules 06/26/13 07/01/13
13-44 Inpatient Hospitals: The agency has new rules for provider preventable conditions (PPCs). The rules establish payment policy for services provided to clients by health care professional and inpatient hospitals that result in provider preventable conditions 06/27/13 07/01/13
13-43 Hospitals, Managed Care: Update coverage and prior authorization requirements for selected procedure codes 06/26/13 07/01/13
13-42 Hospice- Homehealth: Update coverage and fee schedule for selected procedure codes 06/20/13 07/01/13
13-41 Clinicians, Managed Care: Early Periodic Screening Diagnosis and Treatment Medicaid Provider Guide 06/26/13 07/01/13
13-39 Physicians-Related Services: Revisions and updates including phase II of reorganizing guide, policy & coverage updates, PA & EPA changes and additions, and updated procedure codes 06/20/13 07/01/13
13-38 Prescription Drug: Nonbilling individual Providers 06/06/13 08/01/13
13-37 Pharmacy, Managed care: Smoking cessation for pregnant clients 06/11/13 07/01/13
13-36 Prescription Drug: Maximum Allowable Cost Update 05/29/13 07/01/13
13-35 Tribal: IHS Encounter Rate Increase 05/30/13 Retroactive to 01/01/13
(superseded by 13-81)
13-34 Hospitals, Managed Care: Updating Outpatient Hospital Services MPG with revised Sleep Studies policy and updates to prior authorization requirements for new drugs; updating OPPS Fee Schedule with new codes 05/21/13 Retroactive to 04/01/13
13-33 Clinicians, Hospitals, Pharmacy, Managed Care: HCA no longer covers the anemia drug peginesatice (Omontys®) 05/14/13 02/23/13
13-32 Prescription Drug: Patient Review and Coordination program criteria 05/09/13 06/01/13
13-31 Prescription Drug: "Emergency Fills" 05/09/13 06/01/13
13-30 Hospitals, Hospice, Home Health, Nursing homes, Managed care: Revised Nursing Facilities Medicaid Provider Guide with coverage updates 05/15/13 05/15/13
13-29 Mh-RSNs, Hospitals, Substance Abuse, Managed Care: Update coverage for selected procedure codes 06/27/13 07/01/13
13-28 Prescription Drug: Maximum Allowable Cost Update 05/06/13 06/01/13
13-27 Prescription Drug: Update authorization requirements for alpha-agonists 05/07/13 06/01/13
13-26 Dental: Coverage Table updates 05/01/13 05/01/13
13-24 Kidney Centers: The agency no longer covers the anemia drug peginesatide (Omontys®) – procedure code J0890 04/24/13 Superseded
(see 13-33)
13-23 Prescription Drug: Maximum Allowable Cost Update 03/28/13 05/01/13
13-22 Prescription Drug: Revised Washington Expedited Authorization (EA) Lists 04/01/13 05/01/13
13-21 Dental: Coverage changes in the ABC Dental and Dental Related Services MPGs 04/04/13 Retroactive to 01/01/13
13-20 Prescription Drug: Revised Washington Preferred Drug List 03/29/13 05/01/13
13-19 Maternity Support Services/Infant Case Management: Comprehensive revision of the MS/ICM MPG through clarifying, streamlining, updating, and reordering information 03/27/13 04/01/13
13-18 Hospitals, Managed Care: Outpatient Prospective Payment System (OPPS) and Outpatient Hospital Fee Schedule 03/27/13 04/01/13
13-17 Ambulatory Surgery Centers: Revised to clarify the taxonomy, modifier, and billing for multiple surgeries during the same operative session 03/27/13 04/01/13
13-16 (Correction PN13-33: HCA no longer covers the anemia drug peginesatice (Omontys®)
Physicians-Related Services: Revisions and updates including phase I of reorganizing guide, housekeeping, policy & coverage updates, PA & EPA changes and additions, and updated procedures codes
03/27/13 04/01/13
13-15 Prescription Drug: Maximum Allowable Cost Update 03/01/13 04/01/13
13-14 Prescription Drug: Revised Washington Preferred Drug List 02/26/13 03/01/13
13-13 Schools, Managed Care: Updates to the School--based Health Care Services for Children in Special Education MPG 02/22/13 03/10/13
13-12 Hospitals, Clinicians: Revised the Prenatal Genetic Counselor guide to clarify the process for provider enrollment and billing, and correct billing the taxonomy 03/07/13 03/08/13
13-11 Managed Care: revised the "Other DME" fee schedule 02/20/13 03/01/13
13-10 Dental: Update coverage limits for selected CDT procedure codes in the Orthodontic Services Medicaid Provider Guide. 02/05/13 03/01/13
13-09 Prescription Drug: Maximum Allowable Cost Update 02/05/13 03/01/13
13-08 Superseded (see 13-14 above) 02/13/13 03/01/13
13-07 Substance Abuse, Hospitals, Family Services, Managed Care: Chemical-Using Pregnant (CUP) Women Program Medicaid Provider Guide 02/14/13 02/01/13
13-06 Mental Health-RSNs: Mental Health Services for Children, Psychiatric and Psychological Services 02/14/13 Retroactive to 01/01/13
13-05 Dental: Added EPA to D1110 and D4910 for SNF clients; other clarifications to Dental-Related Services MPG. 01/30/13 03/01/13
13-04 Prescription Drug: Maximum Allowable Cost Update 01/14/13 02/01/13
13-01 Prescription Drug: Changes in prescription coverage for Medicare Part D dual-eligible clients. 01/14/13 01/14/13