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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 182. Health Care Authority |
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Chapter 182-543. Durable medical equipment and related supplies, complex rehabilitation technology, prosthetics, orthotics, medical supplies and related services. |
Section 182-543-7300. Expedited prior authorization (EPA).
Latest version.
- (1) The expedited prior authorization process (EPA) is designed to eliminate the need for written and telephonic requests for prior authorization for selected durable medical equipment (DME) procedure codes.(2) The medicaid agency requires a provider to create an authorization number for EPA for selected DME procedure codes. The process and criteria used to create the authorization number is explained in the agency published DME-related billing instructions. The authorization number must be used when the provider bills the agency.(3) Upon request, a provider must provide documentation to the agency showing how the client's condition met the criteria for EPA.(4) A written or telephone request for prior authorization is required when a situation does not meet the EPA criteria for selected DME procedure codes.(5) The agency may recoup any payment made to a provider under this section if the provider did not follow the expedited authorization process and criteria.[Statutory Authority: RCW 41.05.021 and 2013 c 178. WSR 14-08-035, § 182-543-7300, filed 3/25/14, effective 4/25/14. WSR 11-14-075, recodified as § 182-543-7300, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.04.050. WSR 11-14-052, § 388-543-7300, filed 6/29/11, effective 8/1/11.]