Healthcare Providers Claims & Billing

The DOC Health Plan defines which health care services are available to incarcerated individuals, as well as services that are limited or not available. The DOC Pharmaceutical Management & Formulary Manual governs the prescribing of medication to incarcerated individuals. Neither the OHP or the Formulary are a contract or a guarantee of reimbursement for services provided to incarcerated individuals.

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

• Medical & Healthcare Services
• Billing Instructions
• Identification Numbers

Medical & Healthcare Services

Includes medical and health care services provided to incarcerated individuals 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.

Health Services Contracts, Claims, & Benefits Unit

Refer to this section for claims and status information related to services provided while an incarcerated individual is in an inpatient or outpatient status in the hospital, or to transport an incarcerated individual 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 incarcerated individuals 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.

• Billing Instructions
• Medical General Terms & Conditions (pdf)
• Payment Policies
• Physician Related and Professional Healthcare Services
• Drugs and Biologicals
• Anesthesia Services
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies
• 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 DOC Health Plan. 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.

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.

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.

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

• Incarcerated individual Healthcare Providers Billing Instructions (revised 8/1/2012)

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

• Incarcerated individual Healthcare Providers Billing Instructions (revised 4/28/2011)

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

Incarcerated Individuals ProviderOne IDs

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

To find a ProviderOne ID for an incarcerated individuals, in ProviderOne go to the client tab and click on benefit inquiry. Look up the incarcerated individuals 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 incarcerated individuals. 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.