Molina Healthcare of Washington Prior Authorization/ Medication Exception Request Allow 2 business days to process Fax: (800) 869-7791 Phone: (800) 213-5525 Date Patient Name (Last, First, MI) … Rev.0716 Medication Prior Authorization Request Form Coordinated Care, Washington *** Do Not Use This Form for Biopharmaceutical Products *** CoverMyMeds is Coordinated Care’s preferred way to receive prior authorization requests. may result in a denied claim. Anyone between ages 19 to 65, who meets income standards, is eligible. Prior authorization is required for digital hearing aids. Please refer to the Prior Authorization Code Lookup Tool for additional details on services listed. Doc#: PCA-1-016562-09222020_11172020. Billing Guidelines Manual and/or Fee Schedule Medicare Advantage = National Coverage . Referrals You’ll need a referral before you go to a: Specialist; Hospital for nonemergency care Washington Apple Health IMC = HCA Provider . Prior authorization is advanced approval of specific procedures, services, medical devices, supplies, and medications by CHPW. Psychological Testing Request for Authorization. n Counseling services. CHPW APPLE HEALTH PLAN. All covered services must be medically necessary and are subject to prior authorization requirements. Washington Prior Authorization Electronic Submissions (11/2019) All managed care plans and the fee-for-service program serving Apple Health clients use this PDL. Substance Use Disorder (SUD) Forms. Washington Apple Health (Medicaid) is Washington's managed care Medicaid program, providing comprehensive medical benefits to adults, families, people with disabilities, children under 19, and pregnant women who meet income requirements. Find benefits BEHAVIORAL HEALTH Community Health Plan of Washington (CHPW) covers many treatments and services. Launch Availity. Interested in joining our provider network? Telephonic Prior Authorization: 1-855-757-6565 (available 5 a.m. - 5 p.m. PST) Envolve Pharmacy Solutions will respond via fax or phone within 24 hours of receipt of the prior authorization request. And some services need prior authorization. TMS Authorization Request Form (NEW) - electronic submission; Washington Medicaid IMC Authorization Form. 2019 Benefits At-A-Glance . Our Apple Health plan covers kids and adults up to age 64. Claims & Disputes. Jakafi (Washington) Prior Authorization Form - Community Plan. Substance Use Disorders Inpatient Discharge Form. Before you get certain services, you may need a referral from your PCP or preapproval (called prior authorization) from Amerigroup. The Health Care Authority is working with managed care plans that serve Apple Health clients to create the Apple Health PDL. Some services require prior authorization from Coordinated Care in order for reimbursement to be issued to the provider. How CHPW Determines Prior Authorization. n Home health aides. Last Published 06.04.2019. View online or download now. Guidelines and/or Local Coverage Guidelines Cascade Care – Cascade Select = CHNW - Cascade Select Explanation of Coverage (EOC) Failure to obtain the required prior authorization . Substance Use Disorder Inpatient Treatment Prior Authorization and Continued Care Request. Join our network. FFS= services covered with your Medicaid Services Card through Washington Apple Health Medicaid . Molina Healthcare of Washington Phone: (800) 213-5525 Option 1-2-2 | Fax: (800) 869-7791 Urgent . Korlym (Washington) Prior Authorization Form - Community Plan. Prior Authorization Created Date: 7/15/2019 11:39:23 AM We look forward to working with you to provide quality services to our members. If you select the Washington Apple Health Behavioral Health Services Only (BHSO) plan, the lookup tool provides PA and coverage information for behavioral health benefits only. Community Health Plan of Washington and its providers use guidelines for care written by experts in the field of medicine and behavioral health. This Amerigroup Washington, Inc. Apple Health (Medicaid) Provider Manual outlines information for providers serving our Integrated Managed Care (IMC) members and Behavioral Health Services Only (BHSO) members. Kisqali (Washington) Prior Authorization Form - Community Plan. As a leader in integrated managed health care services for the public sector, Amerigroup Washington, Inc. helps adults, low-income families, children, pregnant women, those with disabilities and special needs plans get the health care they need. This list contains prior authorization requirements for care providers who participate with UnitedHealthcare Community Plan in Washington for inpatient and outpatient services. Outpatient Washington Prior Authorization Form. Guidelines Manual and/or Fee Schedule Medicare Advantage = National Coverage . Managed-care plans will continue to use their own preferred drug lists for drugs not included in the Apple Health PDL. The Health Care Authority (HCA) implemented the Apple Health Single PDL on January 1, 2018. We help coordinate physical and behavioral health care and offer education, access to care and disease You or your provider may call us and request a free copy of the decision-making criteria for services. Washington Apple Health IMC & Behavioral Health Services Only = HCA Provider Billing . Improving the Patient Experience CME ; Referrals; Learn about Availity; Patient360; Healthcare Effectiveness Data and Information Set (HEDIS) Medical Management Model; Quality Management; Claims. Prior Authorization Fax: 1-866-399-0929 Prior Authorization Phone: 1-866-716-5099 Clinical Hours: Monday – Friday 7 a.m. - 5 p.m. (PST) Help Desk: 1-877-250-6176 Otherwise we may not pay for the service. At Amerigroup Washington, Inc., we value you as a provider in our network. Benefits of Community Health Plan of Washington care Our three enhanced plans offer different services and benefits to fit your life. Prior authorization is not required for: n Diagnostic and screening tests. NOTE: If you have an Apple Health managed care plan, such as Amerigroup, Community Health Plan of Washington United Healthcare Community Plan, … Our goal is to provide you with the best care possible. To get a referral or preapproval, talk to your primary care provider (PCP). For more info, contact the HCA Medical Assistance Customer Service Center: 1-800-562-3022. Washington Apple Health IMC Behavioral Health Prior Authorization Request Radiology Prior Authorization and Notification Program The radiology prior authorization and notification programs support the consistent use of evidence-based, professional guidelines for diagnostic imaging procedures. Prior Authorization Requirements for Washington Medicaid Effective July 1, 2019 General Information . Washington Apple Health IMC Intake Request Fax Form (updated 9/2019) Washington Electronic Submission Form - commercial providers only. Forms. services through Washington Apple Health non- Have your provider fax your request and supporting paperwork to the Health Care Authority at 1-866-668-1214. The Medicaid Prior Authorization Guide is a listing of codes that allows contracted providers to determine if a prior authorization is required for a health care service and the supporting documentation requirements to demonstrate the medical necessity for a service. Guidelines and/or Local Coverage Guidelines Cascade Care – Cascade Select = CHNW - Cascade Select Explanation of Coverage (EOC) Failure to obtain the required prior authorization . Last Published 01.29.2019. Last Published 06.04.2019. v 52_10.2020. Please refer to the Prior Auth Reference Guide (PDF) for questions. Visit Home health care Prior authorization is required. 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