Offender Healthcare Providers

Provider Relations

Welcome to the Department of Corrections Offender Healthcare Provider website. We will be posting information regularly regarding changes in policy and procedure that will effect our providers.

Bulletins

  • No signed contract on file for dates of service September 1, 2012

If you have not signed a contract with the Department for dates of service September 1, 2012 and after, you are still required to bill through the ProviderOne system, and will be reimbursed at the Medicaid rates. Please direct all questions and concerns to Cynthia Ray–Anderson at (360) 725–8721 or carayanderson@doc1.wa.gov.

  • New Conversion Factor Effective September 1, 2012

DOC will use a single conversion factor for all non–hospital professional provider reimbursement. DOC will continue using current Medicare relative value units multiplied by a conversion factor of $60. Anesthesia services, Ambulance, Drugs and Biologicals, Ambulatory Surgery Center, Durable Medical Equipment, and Prosthetics and Orthotics will continue to have separate fee schedules and reimbursement methodologies.

  • Electronic billing through ProviderOne effective with dates of service September 1, 2012 and after!

Beginning September 1, 2012, all DOC providers will be required to submit claims for services provided to DOC offenders electronically through the Health Care Authority’s (HCA) ProviderOne system. Notification letters were mailed to all DOC providers on June 12, 2012 informing them of this new requirement and the need for all providers who will be billing through ProviderOne to be enrolled and have a Core Provider Agreement with HCA as well as sign a new DOC agreement. The new DOC agreements were mailed on July 31, 2012. Please direct all questions and concerns to Cynthia Ray–Anderson at (360) 725–8721 or carayanderson@doc1.wa.gov.

  • New DOC Fee Schedules Effective January 1, 2012

The new fee schedules for January 1, 2012 are posted. The new fee schedules include the new HCPCS codes and Relative Value Units for those codes only. The rest of the RVU remain the 2011 values.

In addtion, DOC has implemented the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies fee schedule for 2012. Please see the fee schedule for more specific information.

  • New DOC Fee Schedules & Billing Instructions Effective January 1, 2011

The new fee schedules for January 1, 2011 will be posted by December 15, 2010. The new fee schedules will include the new HCPCS codes and Relative Value Units for those codes only. The rest of the RVU remain the 2010 values.

UMP Contracts With Regence for 2011: What it Means to UMP Network Providers; Will UMP Change Pharmacy Benefit Managers in 2011? Notify UMP of Changes; New Drug Program Alerts Providers of Adverse Drug Interactions; BioScrip Launches Oral Oncology Drug Program; Care & Therapy Management Program for Multiple Sclerosis and Rheumatoid Arthritis; Updated UMP Fee Schedules (effective July 1 — December 31, 2010); Non–coverage of Consultation Codes.

Provider Frequently Asked Questions

Why is DOC no longer using Uniform Medical Plan (UMP) fee schedule Relative Value Unit’s (RVU)?

The Washington State Health Care Authority (HCA), the administrator for the Uniform Medical Plan, has contracted with Regence Blue Shield for its administrative services. As a result, the UMP fee schedules will no longer be accessible through the UMP website as of January 1, 2011.

Why did I receive a DOC denial for a person brought in by law enforcement?

In some cases when a patient is brought in by law enforcement the bill is the responsibility of a city⁄county⁄federal correctional facility rather than the state prison system.

Why was payment denied due to Medicaid approval?

When an inmate patient becomes eligible for medical assistance by way of a qualifying event, Medicaid (DSHS) issues a coupon and become the payer for the event and all related services.

Update Mailing List

If you wish to be notified of updates to our publications like fee schedules and billing manuals, please join our health care provider mailing list.

In the email, please specifiy:

  • Name⁄DBA
  • TIN⁄EIN
  • NPI Number
  • Specialty⁄type of services provided

Email your questions or comments about this website, to Beth Goupillon.