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Healthcare Providers Claims & Billing

The Offender Health Plan (OHP)Adobe PDF document file defines which health care services are available to inmates, as well as services that are limited or not available. The DOC Pharmaceutical Management & Formulary ManualAdobe PDF document file governs the prescribing of medication to inmates. Neither the OHP or the Formulary are a contract or a guarantee of reimbursement for services provided to inmates.

Please refer to the links below for more information about claims and billing for health care services rendered to inmates under the jurisdiction of the Department of Corrections (DOC).

Medical & Healthcare Services

Includes medical and health care services provided to inmates inside or outside of Department of Corrections (DOC) prison facilities. Please see the below resources for claims and billing information related to offsite health care services.

Hospitalization & Ancillary Services

Refer to this section for claims and status information related to services provided while an inmate is in an inpatient or outpatient status in the hospital, or to transport an inmate to and/or from an offsite hospital. See the Non-Hospital Related Services section for information related to services provided at ambulatory surgery centers.

Questions regarding coverage or eligibility for DOC inmates should be referred to the Medical Disbursement Unit.

Offsite Hospital Services

With the passage of House Bill 2803 and its enactment into law, providers of hospital services (inpatient or outpatient) must bill and be paid through the HCA ProviderOne system under the rates and methodologies in use by the state Medicaid program. Please refer to the ProviderOne Billing and Resource Guide for questions regarding these services.

Ambulance Transportation Services

Ambulance transports (to and from hospitals) by private companies must be billed through the ProviderOne system. Services will be paid with the same rates and methodologies in use by the state Medicaid program. Please refer to the ProviderOne Billing and Resource Guide for current rates.

Non-Hospital Related Services

Refer to the information in this section for claims and status information related to services provided in physician's offices or ambulatory surgery centers.

Please note 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 ProviderOne, and will be reimbursed at the Medicaid rates. Refer to the ProviderOne Billing and Resource Guide for current rates.

Fee Schedules

These documents contain material that is copyrighted by the American Medical Association (AMA). If you have not read and agreed to the AMA copyright statement, please read it now.

The procedure codes and fee schedule amounts do not necessarily indicate coverage or payment. All coverage and payments are subject to pre-authorization requirements. For detailed billing and coverage information, refer to Billing Instructions and the Offender Health Plan (OHP)Adobe PDF document file. Fees are subject to change without notice. Although every effort is made to ensure the accuracy of the fees, changes or corrections may occur throughout the year.

Professional Provider Fee Schedules
Effective Date File(s) Compressed File
January 1, 2018 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
July 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
July 1, 2015 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2015 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file

Please note that for services provided prior to 1/1/2011, rates for drugs and biologicals administered incident to a provider's professional services are paid according to the provider contract. Contact us for previous fee schedules.

Drugs & Biologicals Fee Schedules
Effective Date File(s) Compressed File
April 1, 2018 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
October 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
July 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
April 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
July 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2016 ExcelMicrosoft Excel document file Not Available
October 1, 2015 ExcelMicrosoft Excel document file Zip Filecompressed zip file
July 1, 2015 ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2015 ExcelMicrosoft Excel document file Zip Filecompressed zip file
Anesthesia Fee Schedules
Effective Date File(s) Compressed File
January 1, 2018 ExcelMicrosoft Excel document file Not Available
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2016 ExcelMicrosoft Excel document file Not Available
January 1, 2015 ExcelMicrosoft Excel document file Zip Filecompressed zip file
Medical Equipment, Prosthetics, Orthotics and Supplies Fee Schedules
Effective Date File(s) Compressed File
April 1, 2018 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2018 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
July 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
April 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
July 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2016 PDFAdobe PDF document file Not Available
Ambulatory Surgery Centers Fee Schedules
Effective Date File(s) Compressed File
January 1, 2018 PDFAdobe PDF document file ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2017 ExcelMicrosoft Excel document file Zip Filecompressed zip file
January 1, 2016 ExcelMicrosoft Excel document file Not Available
January 1, 2015 ExcelMicrosoft Excel document file Zip Filecompressed zip file
Oral Surgery Centers Fee Schedules
Effective Date File(s) Compressed File
January 1, 2018 ExcelMicrosoft Excel document file Not Available
July 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
July 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
January 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
May 1, 2015 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
Denture Services Fee Schedules
Effective Date File(s) Compressed File
January 1, 2018 ExcelMicrosoft Excel document file Not Available
July 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
July 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
April 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available

The Department published a statewide hearing aid fee schedule for Hearing Services HCPCS codes V5000-V5999, effective 8/1/2014 through 6/30/2015. Codes that are not included in the below fee schedules are not covered by the Department. Please note several codes require prior authorization and any by report codes require submissions of documentation with the claim. Refer to the special notes under the fee schedule for more information. Contact us for previous fee schedules or if you have questions.

Hearing Aids Fee Schedules
Effective Date File(s) Compressed File
July 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
January 1, 2017 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
July 1, 2016 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
July 1, 2015 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
May 1, 2015 PDFAdobe PDF document file ExcelMicrosoft Excel document file Not Available
Older Fee Schedules

Two full past years and the current year's fee schedules are posted on this webpage. Please contact us for older fee schedules.

Billing Instructions

These documents contain material that is copyrighted by the American Medical Association (AMA). If you have not read and agreed to the AMA copyright statement, please read it now. These billing instructions are for offsite professional providers, facilities, and hospitals. There is also instructions for professional services provided onsite inside a prison facility (both fee-for-service and hourly contractors).

For dates of service provided on or after 9/1/2012

For dates of service on or after 9/1/2012, claims must be submitted using the ProviderOne electronic billing system. Paper claims submitted to the Department for these dates of service will be denied.

For dates of service provided prior to 9/1/2012

For dates of services prior to 9/1/2012, you may continue to send paper claims to: Department of Corrections, Medical Disbursement Unit, PO BOX 41107 Olympia, WA 98504–1107

Identification Numbers

A National Provider Identifier (NPI) number is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout the industry. See the NPI Registry Public Search for more information.

ProviderOne is an online payment system for healthcare providers serving individuals enrolled in the Apple Health Program, the brand name for all Washington State medical assistance programs, including Medicaid. The ProviderOne ID is a unique identifier of the billing healthcare provider. See the Health Care Authority (HCA) for more information.

Facility Identification Numbers

Below are the National Provider Identifier (NPI) and ProviderOne identification numbers for each Washington State Department of Corrections (DOC) prison facility.

Prison Facility NPI Number ProviderOne ID
AHCC 1902197882 2022856
CCCC 1750672572 202286
CBCC 1902197387 2022854
CRCC 1629369095 2022855
LCC 1538450911 2022849
MCCCW 1689965063 2022851
MCC 1588955306 2022860
OCC 1588955306 2022860
SCCC 1427349802 2022850
WCC 1447541834 2022857
WCCW 1114218591 2022852
WCCW 1164713558 2022859
Headquarters 1861813834 N/A

Inmate ProviderOne IDs

To determine if the inmate is currently incarcerated at a DOC prison facility, use the Inmate Search feature.

To find a ProviderOne ID for an inmate, in ProviderOne go to the client tab and click on benefit inquiry. Look up the inmate by entering the last name, first name, and date of birth in this section.

In some cases, the system will show the subscriber does not have a plan identified (reject reason code 78), however, the system will show the ProviderOne ID number in the client demographic information section on the left side of the screen if one has been assigned to the inmate. Even though the system states a reject reason code, the bill can still be submitted in the ProviderOne system using the assigned number for DOC clients and will not be rejected.

If no number exists in the ProviderOne system, please contact the Claims Benefits Manager.