(1) The expedited prior authorization process (EPA) is designed to eliminate the need for written and telephonic requests for prior authorization for selected medical equipment procedure codes.
(2) The medicaid agency requires a provider to create an authorization number for EPA for selected medical equipment procedure codes. The process and criteria used to create the authorization number is explained in the agency published medical equipment-related billing guide. The authorization number must be used when the provider bills the agency.
(3) Upon request, a provider must provide documentation to the agency showing how the client's condition met the criteria for EPA.
(4) A written or telephone request for prior authorization is required when a situation does not meet the EPA criteria for selected medical equipment procedure codes.
(5) The agency may recoup any payment made to a provider under this section if the provider did not follow the expedited authorization process and criteria.
[Statutory Authority: RCW
41.05.021,
41.05.160 and 42 C.F.R. Part 440.70; 42 U.S.C. section 1396 (b)(i)(27). WSR 18-24-021, § 182-543-7300, filed 11/27/18, effective 1/1/19. Statutory Authority: RCW
41.05.021 and 2013 c 178. WSR 14-08-035, § 182-543-7300, filed 3/25/14, effective 4/25/14. WSR 11-14-075, recodified as § 182-543-7300, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW
74.08.090 and
74.04.050. WSR 11-14-052, § 388-543-7300, filed 6/29/11, effective 8/1/11.]