WSR 97-01-096
INTERPRETIVE OR POLICY STATEMENT
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
[December 18, 1996, 11:53 a.m.]
Document Title: Healthy Options Licensed Health Carriers.
Subject: Supplemental premiums, instructions for billing, rebilling and adjustments.
Effective Date: January 1997.
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.
To receive a copy of the interpretive or policy statement, contact Anne DeJarnette, Administrative Regulations Analyst, Department of Social and Health Services, Medical Assistance Administration, Division of Client Services, P.O. Box 45530, Olympia, WA 98513, phone (360) 664-2320, TDD 1-800-848-5429, FAX (360) 753-7315, e-mail dejarae@dshs.wa.gov.
December 13, 1996
Steven Wish, Section Head
Division of Client Services