WSR 12-09-010



[ Filed April 5, 2012, 10:32 a.m. ]

Notice of Interpretive or Policy Statement

     In accordance with RCW 34.05.230(12), following is a list of policy and interpretive statements issued by the department of social and health services.

Health Care Authority (HCA)

Legal and Administrative Services

     Document Title: Provider Notice #12-23.

     Subject: Outpatient hospitals.

     Effective Date: April 1, 2012.

     Description: Effective for dates of service on and after April 1, 2012, the medicaid program of the health care authority (the agency) will:

Update the Outpatient Hospital and Outpatient Prospective Payment System (OPPS) Fee Schedule with added codes and coverage changes;
Update changes in prior authorization requirements for certain current procedural terminology (CPT¦) codes; and
Implement a utilization review program to determine the medical necessity of emergency room use for conditions that could be treated in a primary care office or urgent care clinic.

     Effective for dates of service on and after April 15, 2012, the medicaid program of the agency will require prior authorization for a select group of surgical procedure codes. Qualis Health or the agency will be conducting the medical necessity review as indicated on the fee schedule. Submitting requests for medically necessary reviews will begin April 1, 2012.

     For additional information, contact Amber Dassow, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail, web site

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