NCPDP D.0 Payer Specification Sheet
WA Health Care Authority Washington State PDL, Prescription Assistance Program Information
Washington Preferred Drug List
Expedited Authorization Code list
State Maximum Allowable Cost (SMAC) list effective 05/01/12
Miscellaneous HCPCS Code Drugs Requiring Prior Authorization
Pharmacy Information
NEW!
ATTENTION PHARMACIES!
Health Advisory: Unintentional overdose deaths are associated with methadone and other opioids. The Pharmacy and Therapeutics Committee has asked the Health Care Authority to distribute a special HEALTH ADVISORY to pharmacists and prescribers. It will be distributed to Medicaid pharmacies and providers statewide on Tuesday, December 27.
THERE IS A CHANGE IN THE SUPPLEMENTAL REBATE BID PROCESS
Please direct any questions about the supplemental rebate bid process to Amy Irwin at 360-725-1725.
Electronic Submission is required and should be sent to Contracts@hca.wa.gov.
The subject line should say: WA Medicaid Supplemental Rebate Offers for April 2012
Implementation of NCPDP Version D.0 Claim Format
On January 1, 2012, the Medicaid Program of the Health Care Authority (the Agency) will implement the NCPDP Version D.0 claim format to comply with Health Insurance Portability and Accountability Act (HIPAA) requirements.
In order to pay claims, the Agency requires providers to use the values in the NCPDP D.0 Payer Specification Sheet.
HCA seeks CMS approval for a Medicaid formulary
To avoid elimination of the pharmacy benefit for Medicaid clients in response to budget shortfalls, the State intends to submit a State Plan Amendment (SPA) to implement a formulary in accord with the provisions of Section 1927 of the Social Security Act. A special session of the Washington State Drug Utilization Review Board will be held on January 18, 2012 to begin the process of developing the proposed formulary. For additional information please see meeting agenda.
For Pharmacies:
The Agency has established the RSV/Synagis® season as December 1, 2011, through April 30, 2012. For additional information, see # Memo 11-61.
Instructions on How to Navigate the Automated System to access a Medicaid Client's ProviderOne ID# was sent out via listserv at 2p.m. on 6/30/11.
Click here to review the message.
Effective 05/01/11, MPA’s Pharmacy Authorization line at 1-800-562-3022 ext. 15483 will be available 8:30a.m.-5p.m. Monday through Friday. For additional information, see our broadcast fax.
For Prescribers:
The Department has updated the barcode cover sheets which are used when submitting supporting documentation, making them easier to use. The new cover sheets will be effective Friday January 14, 2011. The link to the cover sheets will remain the same: http://hrsa.dshs.wa.gov/download/document_submission_cover_sheets.html
If you have saved a cover sheet form to your computer, you will need to start using the updated version on Friday. We recommend saving the link to the cover sheets as a “favorite” rather than saving the document itself, to make sure you are always using the correct version. Additional information on the barcode cover sheet can be located at ProviderOne_Billing_and_Resource_Guide - Appendix_G.
Webinar Information
Submitting Authorization Requests for Pharmacy Services Webinar.
As a result of this webinar, you will be able to locate the new pharmacy authorization request form (13-835A) and instructions; submit your authorization request successfully using the new authorization intake process; submit additional information to an existing request using the new cover sheet; and check the status of your request using the IVR phone system.
See FAQ's from this Webinar here.
Where can I find?
- Pharmacy News and Announcements. Information on new drugs, Healthy Options clients that self refer, Second Opinion Network Providers list, Fair Hearings, information on transportation for clients, Medicare Part D, Preferred Drug List (PDL), Mental Health Pharmaceutical News, and Reports.
- Pharmacy Prior Authorization. Prior Authorization fax forms and the PDL drug list.
- Prescription Billing. Current Expedited Authorization (EA) list, Prescription Drug Program Billing Instructions, HRSA Preferred Drug Lists (PDL), Numbered Memorandums.
- Instructions for requesting 12 month patient history
- WA Preferred Drug List (PDL)
- How to become an Endorsing Prescriber
- Medicaid covered over the counter (OTC) Drug List
- Covered Cough and Cold Product List
- Pharmacy Reimbursement. Request to Change Reimbursement fax form, current SMAC list, AWP-50% exclusions, Federal Upper Limits and NCPDP Billing Standards.
- HRSA Criteria For Authorization of Suboxone.
- Medicaid Opioid Taper Plan Calculator
- Current List of Participating Drug Rebate Manufacturers (Excel spreadsheet).
- List of Drugs Requiring a 90-Day Supply.
- List of Drugs with Limitations
- HCPCS J3490 Drugs Requiring Prior Authorization
For comments or questions: Contact Medicaid.
Join the Medicaid e-mail list for providers. It's free, fast, and informative!
Report suspected Medicaid fraud: 1-800-562-6906 HotTips@HCA.wa.govPage modified: May 2012