Some services require prior authorization from Coordinated Care in order for reimbursement to be issued to the provider. 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. Outpatient Washington Prior Authorization Form. To see what drugs are preferred and whether they need a prior authorization (PA), please go to the Apple Health Single PDL website. Please contact [email protected] with any questions. We look forward to working with you to provide quality services to our members. 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 Reauthorization Patient Information . And some services need prior authorization. Prior Authorization Requirements for Washington Medicaid Effective July 1, 2019 General Information . First Name: MI: Last Name: DOB: Member ID: Physician Information . All covered services must be medically necessary and are subject to prior authorization requirements. Last Published 01.29.2019. n Counseling services. To request prior authorization, please submit y our request online, or by phone. CHPW APPLE HEALTH PLAN. Our goal is to provide you with the best care possible. 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. Prior Authorization. Plan Washington Apple Health Eventos de Medicaid Inicio de sesión Buscar un proveedor Cómo inscribirse ... For specific details, please refer to the provider manual. Prior authorization means your provider has to check with us to make sure we will cover a treatment, drug, or piece of equipment. Prior authorization is advanced approval of specific procedures, services, medical devices, supplies, and medications by CHPW. 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. Claims & Disputes. The Washington Apple Health Medicaid Handbook for members of Coordinated Care tells you how our program works and what we offer. TMS Authorization Request Form (NEW) - electronic submission; Washington Medicaid IMC Authorization Form. The Health Care Authority is working with managed care plans that serve Apple Health clients to create the Apple Health PDL. If you are uncertain that prior authorization is needed, please submit a request for an accurate response. 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. This prior authorization requirem ent is another step we are taking in support of theTriple Aim to improve care experiences, outcomes and total cost of care for UnitedHealthcareCommunity Plan members. That's why we’ve redesigned the provider site to make it more useful for you and easier to use. Launch Availity. Please see current effective date of this guide. Psychological Testing Request for Authorization. Before you get certain services, you may need a referral from your PCP or preapproval (called prior authorization) from Amerigroup. Medical benefits for BHSO members are not provided. may result in a denied claim. Guidelines Manual and/or Fee Schedule Medicare Advantage = National Coverage . Prior authorization review is the process to determine medical necessity of said services, according to clinical care guidelines and utilization management criteria.. 2019 Benefits At-A-Glance . Community Health Plan of Washington and its providers use guidelines for care written by experts in the field of medicine and behavioral health. Substance Use Disorders Inpatient Discharge Form. Our Apple Health plan covers kids and adults up to age 64. Prior Authorization Lookup Tool; Training Academy. Envolve Pharmacy Solutions, Coordinated Care's pharmacy benefit manager (PBM), processes pharmacy claims and administers the medication prior authorization process. 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. This list contains prior authorization requirements for care providers who participate with UnitedHealthcare Community Plan in Washington for inpatient and outpatient services. For more info, contact the HCA Medical Assistance Customer Service Center: 1-800-562-3022. Some of these services require a referral, while others don’t. All managed care plans and the fee-for-service program serving Apple Health clients use this PDL. Billing Guidelines Manual and/or Fee Schedule Medicare Advantage = National Coverage . Washington Apple Health Plan Mental Health Login Find a Provider How to Enroll Benefits and Services Integrated Benefits Overview ... please refer to the provider manual. 2020 . You or your provider may call us and request a free copy of the decision-making criteria for services. Find benefits BEHAVIORAL HEALTH We help coordinate physical and behavioral health care and offer education, access to care and disease Interested in joining our provider network? Washington Apple Health IMC = HCA Provider . 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. Behavioral Health Prior Auth Request Form 2020: Applied Behavior Analysis (ABA) Therapy Prior Authorization Form 2020: Applied Behavior Analysis (ABA) Level of Support Requirement: Applied Behavior Analysis (ABA) Provider UM Guide: FAQs for ABA Treatment Prior Authorization: Prior Auth - Pre-Service Guide Medicaid Effective 01/01/2020 If you are uncertain that prior authorization is needed, please submit a request for an accurate response. To get a referral or preapproval, talk to your primary care provider (PCP). It offers all the care you need, as well as many extra benefits that go beyond Apple Health alone. 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. Substance Use Disorder Inpatient Treatment Prior Authorization and Continued Care Request. Kisqali (Washington) Prior Authorization Form - Community Plan. Improving the Patient Experience CME ; Referrals; Learn about Availity; Patient360; Healthcare Effectiveness Data and Information Set (HEDIS) Medical Management Model; Quality Management; Claims. Otherwise we may not pay for the service. Molina Healthcare of Washington Phone: (800) 213-5525 Option 1-2-2 | Fax: (800) 869-7791 Urgent . Created Date: 7/15/2019 11:39:23 AM Covered services include: n Skilled nursing. Washington Prior Authorization Electronic Submissions (11/2019) Home health care Prior authorization is required. Care Provider Manual. Prior Authorization Requirements. FFS= services covered with your Medicaid Services Card through Washington Apple Health Medicaid . Korlym (Washington) Prior Authorization Form - Community Plan. Last Published 06.04.2019. View online or download now. As of 5/1/2017, Envolve Pharmacy Solution MAC appeals are being managed by CVS Caremark ®. Community Health Plan of Washington (CHPW) covers many treatments and services. Prior authorization is required for digital hearing aids. Drugs and DME require separate prior authorization. Benefits of Community Health Plan of Washington care Our three enhanced plans offer different services and benefits to fit your life. n Home health aides. The Medicaid Prior Authorization Guide may be subject to change at any time. Substance Use Disorder (SUD) Forms. v 52_10.2020. Referrals You’ll need a referral before you go to a: Specialist; Hospital for nonemergency care Forms. Lenvima (Washington) Prior Authorization Form - Community Plan. Anyone between ages 19 to 65, who meets income standards, is eligible. Last Published 06.04.2019. Managed-care plans will continue to use their own preferred drug lists for drugs not included in the Apple Health PDL. Please refer to the Prior Authorization Code Lookup Tool for additional details on services listed. Prior Authorization Visit Washington Apple Health IMC Intake Request Fax Form (updated 9/2019) Washington Electronic Submission Form - commercial providers only. Guidelines and/or Local Coverage Guidelines Cascade Care – Cascade Select = CHNW - Cascade Select Explanation of Coverage (EOC) Failure to obtain the required prior authorization . Please refer to the Prior Auth Reference Guide (PDF) for questions. Join our network. WISe Change in Service Notification Form. At Amerigroup Washington, Inc., we value you as a provider in our network. How CHPW Determines Prior Authorization. Pharmacy Maximum Allowance cost (MAC) Appeal . may result in a denied claim. Doc#: PCA-1-016562-09222020_11172020. NOTE: If you have an Apple Health managed care plan, such as Amerigroup, Community Health Plan of Washington United Healthcare Community Plan, … 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. Prior authorization is not required for: n Diagnostic and screening tests. The Health Care Authority (HCA) implemented the Apple Health Single PDL on January 1, 2018. Jakafi (Washington) Prior Authorization Form - Community Plan. 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. n Hearing aid evaluations. 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