July 2025 Provider News
Date: 07/28/25
In this issue:
- General Updates - Manual reminder, Mental Health IOP & PHP Update, Authorizations Systems Upgrade and Outage Scheduled for Oct. 10, 2025, Reminder not to Bill Apple Health Members
- Quality - Wildfire Season, Asthma, Mammograms, Cervical Cancer Screening, Telehealth, Antidepressant Medication Management, Men's Health
- Clinical & Payment Policies and Prior Authorization Updates - Upcoming Policy Changes
- Wellcare - Reminder Claims Dispute vs. Appeal, Medical Clinical Policy Updates
- Apple Health Core Connections - Billing EPSDTs with the TJ Modifier for higher payment rates
- Training/Education - Washington Integrated Care Assessment (WA - ICA)
- Pharmacy Updates - Test Strip and Lancet Quantity Limit Update Reminder
______________________________________________________________________________________
General Updates
Medicaid Reminder: Providers must adhere to appointment availability and wait times found in the Provider Operations Manual on pages 27-28.
Mental Health IOP & PHP Update: The Washington State Health Care Authority (HCA) has updated the Apple Health (Medicaid) coverage of intensive outpatient programs (PDF) and partial hospitalization programs for mental health services FAQ.
Authorizations Systems Upgrade and Outage Scheduled for Oct. 10, 2025
As part of ongoing system maintenance, authorization systems will be upgraded, requiring a scheduled system outage Friday, Oct. 10 at 10 p.m. CT through Monday, Oct. 13 at 7 a.m. CT.
During this scheduled outage, we will be unable to receive authorization requests except as noted below. Please resume submission of your authorization requests on Monday, Oct. 13, 2025.
How to Plan for the Outage:
- Plan accordingly and submit any urgent or time-sensitive authorization requests prior to the scheduled downtime.
- For urgent authorization requests during the outage, call 1-833-837-0188. Of note, this number will only be active during this downtime.
- Beginning Monday, Oct. 13 at 7 a.m. CT., providers may submit authorization requests as usual.
If you have questions, please contact your Engagement Provider.
Reminder not to Bill Apple Health Members
Providers who contract with the Health Care Authority and any Managed Care Organization cannot bill Apple Health/Medicaid members for covered services without complying with all requirements of WAC 182-502-0160. To avoid violating this regulation, it is important to verify the eligibility of all members who present to your office without insurance or with outdated insurance information!
There are several easy self-service methods to check a patient's enrollment in Washington Apple Health through ProviderOne:
- Log into ProviderOne, click client inquiry under the Benefit Tab for search options
- Submit an electronic individual or batch 270/271 inquiry to ProviderOne
- Swipe the client service card using a magnetic card reader
- Call the Interactive ProviderOne Interactive Voice Response (IVR) 1-800-562-3022
If Coordinated Care coverage is shown, you may verify ID number and benefits through the following methods:
- Recipient Eligibility Verification System (REVS)
- Coordinated Care Provider Portal
- Coordinated Care Interactive Voice Response (IVR) 1-877-644-4613
______________________________________________________________________________________
Quality
Medicaid Quality
Wildfire Season
For those impacted by fires in Washington- status updates and shelter resources can be found here.
Asthma and 90 Day Medication Refills Moving patients with asthma to 90-day refills may help increase their adherence to maintenance medication.
Mammograms (HEDIS Measure)
The HEDIS measure assesses women ages 50-74 who had at least one mammogram to screen for breast cancer in the past 2 years.
Cervical Cancer Screening (HEDIS Measure)
The HEDIS measure assesses women ages 21-64 who fit certain criteria. Please refer to the following link for more information
Telehealth
Telehealth increases access to physicians and specialists to help patients receive the right care, at the right place, at the right time.
Antidepressant Medication Management (HEDIS Measure)
The HEDIS measure assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on their antidepressant medications.
Wellcare Quality
Men’s Health: Encourage Your Patients to Prioritize Their Health
Men’s Health Week is the perfect time to talk with your patients about preventable health issues, and encourage early detection and treatment. Medicare covers preventive services, including:
- Alcohol misuse screening and counseling
- Cancer screening: colorectal and prostate
- Cardiovascular disease: screening tests and intensive behavioral therapy (IBT)
- Counseling to prevent tobacco use
- IBT for obesity
Find out when your patient is eligible for services.
If you need help, contact your eligibility service provider.
More Information:
- Hypertension (PDF)
- Obesity (PDF)
- Prostate Cancer (PDF)
- Tobacco Use (PDF)
- Preventive & Screening Services
The HEDIS measure assesses women ages 50-74 who had at least one mammogram to screen for breast cancer in the past 2 years.
Alcohol misuse screening and counseling
Cancer screening: colorectal and prostate
Cardiovascular disease: screening tests and intensive behavioral therapy (IBT)
Counseling to prevent tobacco use
Find out when your patient is eligible for services (PDF). If you need help, contact your eligibility service provider.
More Information:
- Hypertension (PDF)
- Obesity (PDF)
- Prostate Cancer (PDF)
- Tobacco Use (PDF)
- Preventive & Screening Services
_______________________________________________________________________________________
Clinical & Payment Policies and Prior Authorization Updates
Clinical Policy Updates
The below policies were updated as part of our regular monthly review in May. The policy changes are effective July 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
WA.CP.MP.530 | Bone Morphogenic Proteins for Use in Spinal Fusion | Apple Health & Ambetter |
WA.CP.MP.516 | Carotid Artery Stenting | Apple Health |
WA.CP.MP.525 | Catheter Ablation for SVTA | Apple Health |
WA.CP.MP.532 | Chronic Migraine and Tension-Type Headaches | Apple Health |
CP.MP.114 | Disc Decompression Procedures | Apple Health & Ambetter |
CP.MP.115 | Discography | Apple Health & Ambetter |
WA.CP.MP.514 | Extra-Corporeal Membrane Oxygenation Therapy (ECMO) | Apple Health |
WA.CP.MP.54 | Hospice | Apple Health |
WA.CP.MP.531 | Imaging for Breast Cancer Screening | Apple Health |
CP.MP.244 | Liposuction of Lipedema | Apple Health & Ambetter |
CP.MP.116 | Lysis of Epidural Lesions | Apple Health & Ambetter |
WA.CP.MP.518 | Negative Pressure Wound Therapy for Home Use | Apple Health |
CP.MP.24 | Multiple Sleep Latency Testing | Apple Health & Ambetter |
CP.MP.188 | Pediatric Oral Function Therapy | Apple Health & Ambetter |
CP.MP.210 | Repair of Nasal Valve Compromise | Apple Health & Ambetter |
WA.CP.BH.200 | Transcranial Magnetic Stimulation (TMS) for TRMD | Apple Health |
WA.CP.MP.534 | Upright Positional MRI | Apple Health |
The below policies were updated as part of our regular monthly review in May. The policy changes are effective October 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CP.MP.132 | Heart-Lung Transplant | Apple Health & Ambetter |
CP.MP.58 | Intestinal and Multivisceral Transplant | Apple Health & Ambetter |
CP.MP.87 | Therapeutic Utilization of Inhaled Nitric Oxide | Apple Health & Ambetter |
CP.BH.200 | Transcranial Magnetic Stimulation (TMS) for TRMD | Ambetter |
WA.CP.MP.522 | Varicose Vein Treatment | Apple Health |
WA.CP.MP.12 | Vagus Nerve Stimulation | Apple Health |
The below policies are new effective July 1, 2025. You will find the policies posted on the policy Web site.
Policy Number | Policy Title | Line of Business | |
WA.CP.MP.530 | Bone Morphogenic Proteins for Use in Spinal Fusion | Ambetter | |
WA.CP.MP.516 | Carotid Artery Stenting | Ambetter | |
WA.CP.MP.525 | Catheter Ablation for SVTA | Ambetter | |
WA.CP.MP.532 | Chronic Migraine and Tension-Type Headaches | Ambetter | |
WA.CP.MP.514 | Extra-Corporeal Membrane Oxygenation Therapy (ECMO) | Ambetter | |
WA.CP.MP.531 | Imaging for Breast Cancer Screening | Ambetter | |
WA.CP.MP.518 | Negative Pressure Wound Therapy for Home Use | Ambetter | |
WA.CP.MP.534 | Upright Positional MRI | Ambetter | |
The below policies are new effective October 1, 2025. You will find the policies posted on the policy Web site.
Policy Number | Policy Title | Line of Business | |
WA.CP.MP.12 | Vagus Nerve Stimulation | Ambetter | |
WA.CP.MP.522 | Varicose Vein Treatment | Ambetter | |
The below policy will be archived effective September 31, 2025.
Policy Number | Policy Title | Line of Business |
CP.MP.146 | Sclerotherapy for Varicose Veins | Ambetter |
The below policies were previously announced as revised effective on the date noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.BH.104 | Applied Behavior Analysis | 7/1/25 | Apple Health & Ambetter |
CP.BH.105 | Applied Behavioral Analysis Documentation Requirements | 7/1/25 | Apple Health & Ambetter |
WA.CP.MP.515 | Fecal Microbiota Transplantation | 7/1/25 | Apple Health |
CP.MP.121 | Homocysteine Testing | 7/1/25 | Apple Health & Ambetter |
CP.MP.82 | NICU Apnea Bradycardia Guidelines | 7/1/25 | Apple Health & Ambetter |
CP.MP.81 | NICU Discharge Guidelines | 7/1/25 | Apple Health & Ambetter |
WA.CP.MP.526 | Stem Cell Therapy for Musculoskeletal Conditions | 7/1/25 | Apple Health |
CP.MP.162 | Tandem Transplant | 7/1/25 | Apple Health & Ambetter |
WA.CP.MP.510 | Tinnitus Treatment | 7/1/25 | Apple Health |
CP.MP.163 | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | 7/1/25 | Apple Health & Ambetter |
CP.MP.55 | Assisted Reproductive Technology | 8/1/25 | Ambetter |
CP.BH.201 | Deep Transcranial Magnetic Stimulation (TMS) for OCD | 8/1/25 | Ambetter |
CP.MP.132 | Heart-Lung Transplant | 8/1/25 | Apple Health & Ambetter |
WA.CP.MP.69 | Intensity-Modulated Radiotherapy | 8/1/25 | Apple Health |
CP.MP.57 | Lung Transplant | 8/1/25 | Apple Health & Ambetter |
WA.CP.MP.517 | Testosterone Testing | 8/1/25 | Apple Health |
WA.CP.MP.520 | Tympanostomy Tubes | 8/1/25 | Apple Health |
CP.BH.500 | Behavioral Health Treatment Documentation Requirements | 9/1/25 | Apple Health |
HIM.CP.BH.500 | Behavioral Health Treatment Documentation Requirements | 9/1/25 | Ambetter |
WA.CP.MP.513 | Cardiac Stents | 9/1/25 | Apple Health |
WA.CP.MP.502 | Cochlear Implants | 9/1/25 | Apple Health |
CP.MP.50 | Drugs of Abuse: Definitive Testing | 9/1/25 | Ambetter |
WA.CP.MP.505 | Microprocessor-Controlled Lower Limb Prosthetics | 9/1/25 | Apple Health |
CP.MP.147 | Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention | 9/1/25 | Ambetter |
WA.CP.MP.185 | Skin Substitutes | 9/1/25 | Apple Health |
CP.MP.185 | Skin Substitutes for Chronic Wounds | 9/1/25 | Ambetter |
CP.MP.247 | Transplant Service Documentation Requirements | 9/1/25 | Apple Health & Ambetter |
The below new policies were previously announced effective on the dates noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
WA.CP.MP.510 | Tinnitus Treatment | 7/1/25 | Ambetter |
WA.CP.MP.526 | Stem Cell Therapy for Musculoskeletal Conditions | 7/1/25 | Ambetter |
WA.CP.MP.515 | Fecal Microbiota Transplantation | 7/1/25 | Ambetter |
WA.CP.MP.69 | Intensity-Modulated Radiotherapy | 8/1/25 | Ambetter |
WA.CP.MP.517 | Testosterone Testing | 8/1/25 | Ambetter |
WA.CP.MP.520 | Tympanostomy Tubes | 8/1/25 | Ambetter |
CP.MP.50 | Drugs of Abuse: Definitive Testing | 9/1/25 | Apple Health |
WA.CP.MP.513 | Cardiac Stents | 9/1/25 | Ambetter |
WA.CP.MP.502 | Cochlear Implants | 9/1/25 | Ambetter |
WA.CP.MP.505 | Microprocessor-Controlled Lower Limb Prosthetics | 9/1/25 | Ambetter |
The below policies were previously announced as being archived on the dates noted.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.69 | Intensity-Modulated Radiotherapy | 7/31/25 | Ambetter |
WA.CP.MP.50 | Drugs of Abuse: Definitive Testing | 8/31/25 | Apple Health |
Prior Authorization Updates
The following skin substitutes will require prior authorization for Apple Health members effective September 1, 2025:
Code | Description |
C9363 | Skin substitute (Integra Meshed Bilayer Wound Matrix), per sq cm |
Q4100 | Skin substitute, not otherwise specified |
Q4103 | Oasis burn matrix, per sq cm |
Q4108 | Integra matrix, per sq cm |
Q4122 | DermACELL, Dermacell AWM or DermACELL AWM Porous, per sq cm |
Q4123 | AlloSkin RT, per sq cm |
Q4126 | MemoDerm, DermaSpan, TranZgraft or Integuply, per sq cm |
Q4127 | Talymed, per sq cm |
Q4134 | Hmatrix, per sq cm |
Q4135 | Mediskin, per sq cm |
Q4136 | E Z Derm, per sq cm |
Q4138 | BioDFence DryFlex, per sq cm |
Q4140 | BioDFence, per sq cm |
Q4143 | Repriza, per sq cm |
Q4147 | Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm |
Q4149 | Excellagen, 0.1 cc |
Q4150 | AlloWrap DS or dry, per sq cm |
Q4153 | Dermavest and Plurivest, per sq cm |
Q4157 | Revitalon, per sq cm |
Q4161 | Bio-connekt wound matrix, per sq cm |
Q4162 | WoundEx Flow, BioSkin Flow, 0.5 cc |
Q4163 | Woundex, bioskin, per sq cm |
Q4164 | Helicoll, per sq cm |
Q4165 | Keramatrix or Kerasorb, per sq cm |
Q4167 | Truskin, per sq cm |
Q4168 | AmnioBand, 1 mg |
Q4169 | Artacent wound, per sq cm |
Q4173 | Palingen or Palingen Xplus, per sq cm |
Q4174 | PalinGen or ProMatrX, 0.36 mg per 0.25 cc |
Q4176 | Neopatch or therion, per sq cm |
Q4177 | FlowerAmnioFlo, 0.1 cc |
Q4179 | FlowerDerm, per sq cm |
Q4180 | Revita, per sq cm |
Q4181 | Amnio Wound, per sq cm |
Q4182 | Transcyte, per sq cm |
Q4183 | Surgigraft, per sq cm |
Q4184 | Cellesta or Cellesta Duo, per sq cm |
Q4190 | Artacent AC, per sq cm |
Q4191 | Restorigin, per sq cm |
Q4193 | Coll-e-Derm, per sq cm |
Q4194 | Novachor, per sq cm |
Q4198 | Genesis Amniotic Membrane, per sq cm |
The following services were previously announced as requiring prior authorization effective July 1, 2025.
Line of Business | Code | Description |
Ambetter | J1439 | Injection, ferric carboxymaltose, 1 mg |
Apple Health | 37229 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy |
Apple Health | 37227 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral, with transluminal stent placement(s) and atherectomy |
Apple Health | 42145 | Palatopharyngoplasty |
Apple Health | E2402 | Negative pressure wound therapy electrical pump, stationary or portable |
Apple Health | L1833 | Knee orthosis, adjustable knee joints, positional orthosis, rigid support, off-the-shelf |
Apple Health | L0650 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), lateral strength provided by rigid lateral frame/panel(s), off-the-shelf |
Apple Health | L0648 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, off-the-shelf |
Apple Health | L0637 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, prefabricated item, customized to fit |
Due to changes in reimbursement and benefit limitations for Apple Health members which were effective April 1, 2025, we will no longer require prior authorization for G0481 (Definitive Drug Testing, 8-14 Drug Classes) effective July 1, 2025. Please remember that the benefit limit for definitive drug testing is now 12 total services per year.
Payment Policy Updates
The below policy was updated as part of our regular monthly review in April. The policy change is effective June 1, 2025. You will find the policy, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CC.PP.206 | SNF Leveling | Apple Health & Ambetter |
______________________________________________________________________________________
Wellcare
REMINDER: Claims Dispute vs. Appeal Provider Partner,
We understand that there is sometimes confusion between a claim dispute and a claim appeal. The Provider Portal (and/or the Availity platform) is the fastest way to get help with Claims, Claims Disputes, Corrections and Status. Below is a quick guide to help you choose the right path so that your requests are processed without delay:
What is a Claim Dispute?
A claim dispute happens before a formal denial. It is when you disagree with something on a claim, such as:
- A billing error
- A coverage question
- A misunderstanding about a policy
You may contact us to fix a mistake or to ask questions. This is the first step you take if something does not seem right.
Examples include:
- Bundling or unlisted procedure codes
- Non-covered codes
- Questions about timely filing
- Incidental procedures
Disputes must be submitted in writing within 90 calendar days from the denial date on the Explanation of Payment (EOP). We review complete requests within 30 calendar days.
For more information and Claims forms, please visit the Wellcare website, select your state, and click on Claims under Medicare.
Wellcare
Attn: Claim Payment Disputes
P.O. Box 31370 Tampa, FL 33631-3370
Fax: 1-877-277-1808
What is a Claim Appeal?
An appeal is a formal request to challenge a denial after a decision has been made. You use the appeal process if you believe a claim was wrongly denied. Explanation of Payment Codes include DN001, DN038, DN039, VSTEX, HRM16 and KYREC. However, this is not an all-encompassing list of Appeals codes. Anything else related to authorization, or medical necessity that is in question should be sent to the Appeals PO Box with all substantiating information.
Common reasons for appeals include:
- Lack of prior authorization
- Benefits were used up
- Service or days billed were over the authorized amount
- Payment error
- Authorization was denied or expired
- No medical records were received
You must submit your appeal within 90 calendar days from the denial date.
Wellcare
Attn: Appeals Department
PO Box 31368
Tampa, Fl 33631
We Are Here to Help
We want to make sure your claims are processed correctly the first time. Using the right process (dispute or appeal) helps us give you faster answers. If you are unsure which applies, contact us at 1-800-225-8017 (TTY 711) or reach out to your Provider Engagement representative.
For Explanations of Payment (EOPs) and/or remittance advice please obtain electronic versions on the PaySpan website. If you are new to PaySpan or need assistance with your account please contact them at providersupport@payspanhealth.com. You can also access EOPs on Availity.
Thank you for the work you do and for being a valued partner in care.
Medical Clinical Policy Updates
View the Wellcare website to see upcoming clinical policy updates that will go into effect August 1st.
______________________________________________________________________________________
Apple Health Core Connections
Coordinated Care is the single managed care organization to administer the Integrated Managed Care Apple Health Foster Care program serving children and youth in foster care, adoption support, alumni of foster care (ages 18-26), children reunified with their parents, and youth in the Unaccompanied Refugee Minor program. Coordinated Care’s program is named “Apple Health Core Connections.” For questions or care coordination referrals you can reach us at 1-844-354-9876 or AHCCTeam@coordinatedcarehealth.com.
EPSDT: When youth are removed from their home, they need to have an EPSDT exam completed within 30 days. The appointment must be billed as an EPSDT exam, not as establishing care or office visit. Coordinated Care has NO benefit maximum on EPSDT exams for this population. If asked to schedule an EPSDT, please set the appointment even if the patient has had an EPSDT recently. Payment for the EPSDT will be made even if the provider is not the assigned PCP. An EPSDT exam may also be needed after a child changes placement (moves from one caregiving home to another).
Reminder for Billing Teams: Please use the TJ modifier for youth for Apple Health Core Connections members to receive an increased rate for EPSDT visits.
EPSDT Well-Child Program Billing Guide (PDF)
Washington State Health Care Authority (HCA) For all other payable procedure codes, refer to the Physician-Related Services Fee Schedule. For all payable drugs and biologicals, refer to the Professional Administered Drugs Fee Schedule. | |||||
Code Status Indicator | Code | Modifier | Maximum Allowable NFS Fee | Maximum Allowable FS Fee | Foster Care Clients – Must use Mod TJ |
R | 99381 |
| $80.42 | $51.98 | $120.00** |
R | 99382 |
| $84.14 | $55.94 | $120.00** |
R | 99383 |
| $87.17 | $59.20 | $120.00** |
R | 99384 |
| $97.66 | $69.93 | $120.00** |
R | 99385 |
| $95.10 | $67.13 | $120.00** |
R | 99391 |
| $72.02 | $47.55 | $120.00** |
R | 99392 |
| $76.45 | $51.98 | $120.00** |
R | 99393 |
| $76.45 | $51.98 | $120.00** |
R | 99394 |
| $83.45 | $59.20 | $120.00** |
R | 99395 |
| $85.78 | $61.30 | $120.00** |
**For ages 0-20, please see the Enhanced Pediatric fee schedule. For foster care preventative visits, continue to use mod TJ to receive the enhancement.
______________________________________________________________________________________
Training/Education
Trauma and Food: What is the connection? This training will discuss the reasons behind food related issues such as eating too fast or too much, hiding and stealing food, arguing over meal selections, etc. It is designed for those treating, supporting and caring for children who have experienced trauma and may now have "quirky" behaviors around food. We will discuss how trauma affects childhood development, as well as offer practical and easy ideas to help regarding this common concern! Tuesday July 29th, 2025 01:00 – 03:00pm Register.
Cultural Care & Connections: Supporting Native American Tribal Families and Youth This training explores the importance of honoring cultural differences when caring for Native American children and youth, particularly those placed outside of their tribal communities. Participants will gain insight of tribal communities, as well as the impact of historical and intergenerational trauma. The training also helps caregivers identify potential cultural barriers— including in areas of personal care—and provides strategies for offering respectful, inclusive support. Emphasis is placed on the vital need to keep Native children connected to their tribal heritage, extended family, and community in alignment with the Indian Child Welfare Act (ICWA) and tribal sovereignty. Monday Aug 4th 10:00 am – 11:30am Register.
Resiliency Coordinated Care’s Resilience Training provides information on how to foster resilience in children. It reviews research from Ann Masten and Laurence Gonzales to guide discussion. This training looks at factors that effect resilience, the human adaptive process, ways to successfully cope with trauma, and the 12 steps of successful survivors. The training ends with a discussion around how caregivers can help their children feel safe, capable and loveable. Wednesday Aug 6th 12:00pm – 1:30pm Register.
Childhood Development & the Impact of Trauma: This training provides information on key areas of childhood development; social, cognitive, and physical development are all explored. The training focuses on how complex trauma affects development in infants and toddlers, school aged children, and adolescents Wednesday Aug 6th, 2025 05:30 – 07:15pm Register.
Sexual Health in Foster Care Sexual Health and Foster Care examines reproductive and sexual health in relationship to the foster care system. Foster youth often have higher rates of risky sexual behavior, higher rates of negative sexual outcomes, higher rates of sexual exploitation, and become sexually active earlier than their peers. This training will help participants better understand the sexual health needs of foster youth and how they can help meet these needs. Wednesday Aug 8th 12:00pm – 1:30pm Register.
Supporting LGBTQIA+ Youth in Foster Care This curriculum was developed through Amara with input from Coordinated Care and guidance from many community organizations. This training is for caregivers and professionals who work in the child welfare setting. Wednesday Aug 13th 12:00pm – 1:30pm Register.
Helping Mental Health Providers Achieve Outcomes that Matter Most The National Center for Adoption Competent Mental Health Services is hosting a live webinar on August 14th from 10:00-11:00am PDT discussing what youth and families truly want from behavioral health services. Learn how adoption competent, family-informed approaches can drive better care experiences and outcomes across mental health and child welfare services. Register.
Suicide Prevention Provides an overview of the topic of suicide, signs and symptoms, and how caregivers should respond in times of crisis. The training will dive into the rates of youth suicide, risk factors, and proactive steps to take for prevention. Thursday Aug 14th 12:00pm – 1:30pm Register.
Back to School we go! School is often a challenge for children with a history of trauma and it can be challenging to all involved to help kids succeed. This training provides tips & guidance on how professionals and caregivers can help children ease back into school, while recognizing the impacts of their past trauma and experiences. Tuesday Aug 19th, 2025 05:30-07:30 Register.
The Washington Integrated Care Assessment (WA - ICA)
The Washington Integrated Care Assessment (WA-ICA) is a standardized assessment that has been implemented with the intent to advance clinical integration for outpatient primary care and behavioral health settings. This assessment has been recommended and reviewed in partnership between the Health Care Authority (HCA), Washington’s Accountable Communities of Health (ACHs) and the five Medicaid managed care organizations (MCOs) including Coordinated Care of Washington.
This tool was selected to be used by primary care and behavioral health providers in order to:
- Develop a roadmap for clinical practices to advance integration.
- Understand the level of and progress towards clinical integration within primary care and behavioral health practices.
- Improve patient outcomes.
Please consider visiting the HCA website for more information and to determine if utilizing this assessment would be appropriate for your practice.
Helpful Links:
Back to Top
______________________________________________________________________________________
Pharmacy Updates
Test Strip and Lancet Quantity Limit Update
Effective August 01, 2025, Coordinated Care will be aligning with the Health Care Authority’s (HCA) quantity limits for test strips and lancets.
For children, age 20 and younger, as follows:
Insulin dependent, 300 test strips and 300 lancets per member, per month. Expedited Authorization (EA) Code is required.
Noninsulin dependent, 100 test strips and 100 lancets per member, per month.
For adults age 21 and older:
Insulin dependent, 100 test strips and 100 lancets per member, per month. For pharmacy point of sale, EA is required.
For noninsulin dependent, 100 test strips and 100 lancets per member, every 3 months.
For pregnant women with gestational diabetes or had diabetes prior to pregnancy, Coordinated Care pays for the quantity necessary to support testing as directed by the member’s physician, up to 60 days postpartum. For pharmacy point of sale, EA is required.