WSR 98-05-050

INTERPRETIVE OR POLICY STATEMENT

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

[Filed February 13, 1998, 3:55 p.m.]

Document Title: Healthy Options Licensed Health Carriers Billing Instructions and 98-04 MAA Numbered Memo.

Subject: Supplemental premiums: Instructions for billing, rebilling and adjustments.

Effective Date: February 1998.

Document Description: This publication includes Supplemental Premiums Information and Policy, Supplemental Premium Procedure Codes, Instructions for Completing HCFA-1500 Claim Forms, Rebillings and Adjustments, Instructions for Completing the Adjustment Request Form 525-109, and Multiple Premium Payment Adjustment; the numbered memo explains the changes which have occurred in this billing instruction since the last billing instruction printed January 1996.

To receive a copy of the interpretive or policy statement, contact Leslie Baldwin, RI Coordinator, Department of Social and Health Services, Medical Assistance Administration, Division of Program Support, P.O. Box 45530, Olympia, WA 98513, phone (360) 664-2320, TDD 1-800-848-5429, FAX (360) 753-7315, e-mail baldwl@dshs.wa.gov.

February 9, 1998

Roxie Schalliol, Section Head