Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-500 - Medical definitions › Section 182-500-0085 - Medical assistance definitions-P

Current through Register Vol. 24-14, July 15, 2024
"Patient transportation"
means client
				  transportation to or from covered health care services under federal and state
				  health care programs.
"Physician"
means a doctor of medicine,
				  osteopathy, naturopathy, or podiatry who is legally authorized to perform the
				  functions of the profession by the state in which the services are
				  performed.
"Prescribing provider"
means a health care
				  professional authorized by law or rule to prescribe drugs to Washington apple
				  health clients.
"Prior authorization"
means the requirement that
				  a provider must request, on behalf of a client and when required by rule or
				  agency billing instructions, the agency or the agency's designee's approval to
				  provide a health care service before the client receives the health care
				  service, prescribed drug, device, or drug-related supply. The agency or the
				  agency's designee's approval is based on medical necessity. Receipt of prior
				  authorization does not guarantee payment. Expedited prior authorization and
				  limitation extension are types of prior authorization.
"Prosthetic device"
means a preventive,
				  replacement, corrective, or supportive device prescribed by a licensed provider
				  within their scope of practice under state law.
"Provider"
means an institution, agency, or
				  person that is licensed, certified, accredited, credentialed, or registered
				  according to state law, is an eligible provider type according to WAC
				  182-502-0002, authorized to
				  provide services to Washington apple health clients, and has a signed core
				  provider agreement, a nonbilling provider agreement, or other contract with the
				  agency or is a servicing provider.
(a)
"Servicing provider"
means a health care professional screened and
				enrolled with the agency under a group, facility, or organization that has a
				signed core provider agreement (CPA).
(b)
"Nonbilling provider"
means
				a health care professional enrolled with the agency only as an ordering,
				referring, prescribing provider for the Washington medicaid program and who is
				not otherwise enrolled as a medicaid provider with the agency.
"Provider guide"
means an agency publication
				  that describes a specific benefit covered under Washington apple health, which
				  includes client eligibility verification instructions, provider
				  responsibilities, authorization requirements, coverage, billing, and how to
				  complete and submit claims.
"Public institution"
see "institution" in WAC
				  182-500-0050.
Statutory
				  Authority: 42 C.F.R.
				  455.410,
				  RCW
				  41.05.021. WSR 13-19-037, §
										182-500-0085, filed 9/11/13,
				  effective 10/12/13. WSR 11-14-075, recodified as §
										182-500-0085, filed 6/30/11,
				  effective 7/1/11. Statutory Authority:
				  RCW
				  74.08.090 and
				  2011 1st sp.s. c
				  15 . WSR 11-14-053, § 388-500-0085, filed
				  6/29/11, effective 7/30/11. WSR 13-18-003, §
										182-500-0085, filed 8/21/2013,
				  effective 9/21/2013