Wash. HCA Hospice Services Billing Guide, Are clients enrolled in managed care eligible for PPC services?

Yes. When verifying eligibility using ProviderOne, if the client is enrolled in an

HCA-managed care plan, managed care enrollment will be displayed on the client

benefit inquiry screen. A client enrolled in one of the HCA-contracted managed

care plans must receive all PPC services, including nursing facility room and

board, directly through that plan. The client’s managed care plan is responsible

for arranging and providing for all PPC services for a client enrolled in a managed

care plan. Clients can contact their managed care plan by calling the telephone

number provided to them. HCA does not process or reimburse claims for

managed care clients for services provided under the Apple Health contract.

Note: To prevent billing denials, check the client’s eligibility

before scheduling services, and at the time of the service to

make sure proper authorization or referral is obtained from the

plan.

See HCA’s ProviderOne Billing and Resource Guide for

instructions on how to verify a client’s eligibility.