IMPORTANT NEWS

Attention Providers!
All Healthy Options (HO) managed care plans implemented a Patient Review and Coordination (PRC) program as of January 1, 2008, for their HO members to comply with the HO Contract.   The PRC Washington Administrative Code (WAC) 388-501-0135 is currently being amended and is expected to be effective March 9.  The WAC will reflect the following major changes for HO managed care members: 

  • HO members will be placed with one HO managed care plan for one year.
  • HO members will have their DSHS Medical ID card marked with the PRC placement.
  • HO members must remain in the PRC Program whether the member changes plans or becomes Fee-for-Service.
  • HO members will have appeal rights through the health plan and DSHS hearing rights after the appeal is completed.

Attention Pharmacies
 10/29/07 - HRSA has modified the Emergency Contraception (EC) Counseling section on pages F.3 and F.4 of the November 1st effective Prescription Drug Program Billing Instructions.  Effective November 1, 2007, pharmacies are no longer required to submit ECC protocols to HRSA prior to billing.

Fee Schedules
 Need to find Fee Schedule, click link below.
 http://maa.dshs.wa.gov/RBRVS/Index.html
Coverage Tables
 Coverage tables may be found within the billing instructions; they contain procedure codes, descriptions, and policies e.g., Prior Authorization or Limitations.  Coverage tables do not contain fees.