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WA Health Care Authority Updates

The Washington State Health Care Authority (HCA) recently issued two provider alerts regarding incorrect Apple Health claim denials and paper claims submissions. 

Health Care Authority Working to Fix Incorrect Apple Health Claim Denials

A recent change to ProviderOne caused the Health Care Authority (HCA) to deny some fee-for-service claims in error. The affected claims were denied as “prior authorization required.”

HCA will update ProviderOne on July 29, 2016, to correct this problem. After that fix, claims should no longer deny incorrectly for authorization requirements.

Please do not resubmit claims denied for this reason between now and July 29. 

HCA will reprocess the affected claims for providers after July 29 to pay these claims. Providers should see the reprocessed claims on their August 5 and August 12 remittance advices, where claims will appear as either paid or with a correct reason for denial.

If claims submitted after July 29 are inappropriately denied, please contact the HCA Customer Service Center at 1-800-562-3022.

Apple Health Paper Claims Submission Practices Changing

Effective October 2016, the Health Care Authority (HCA) will accept only electronic claims for Apple Health (Medicaid) services, except under very limited circumstances.

We are making this change to improve efficiency in processing claims.  

Providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically. Examples of these unusual circumstances may include but are not limited to:

• HCA notifies provider in writing that paper claims will be accepted due to ProviderOne System issues precluding acceptance of electronic claims.
• The provider can demonstrate that the information needed for adjudication of an Apple Health (Medicaid) claim cannot be submitted electronically using the claim formats required under the ProviderOne Billing and Resource Guide.
• The provider is experiencing a disruption in their electricity or communication connection that is outside of his or her control and is expected to last longer than two days. This exception applies only while electricity or electronic communication is disrupted.
• Providers that have not submitted any electronic claims within the past state fiscal year (July 1, 2015 to June 30, 2016).

Providers who wish to ask for an exemption from submitting claims electronically may do so using the Request a Waiver form. Look for this form to arrive with a second notice in August.

If you need further information regarding this notice, please contact the HCA Customer Service Center at 1-800-562-3022.

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