Wash. HCA Hospice Services Billing Guide, How should the hospice agency confirm the client’s pending medical eligibility?

The ProviderOne system does not show information about clients whose

eligibility is pending. To confirm if a client has applied for Apple Health, call the

client’s Home and Community Services (HCS) office or Community Services Office

(CSO).

• The following are examples of questions the hospice agency may ask when

confirming pending medical eligibility:

o Has the application been received by the CSO/HCS office?

o Does the CSO or HCS office need additional information before benefits

can be approved or denied?

o Has the application been processed? Is the client subject to a spenddown?

(See HCA’s ProviderOne Billing and Resource Guide for instructions on

how to verify a client’s eligibility.)

Note: The HCA/Medicaid Hospice Notification form, HCA 13-746

must be submitted within 5 business days of a client electing

hospice services, regardless of a pending application. Case

managers must determine if clients will need Medicaid eligibility

when electing hospice. If a person electing hospice applies for

Medicaid, the HCA/ Medicaid Hospice Notification form, HCA 13-

746 must be submitted to determine the correct program. This

helps prevent inappropriate denials and avoids duplication of

services by the hospice agency and HCS.

Use one of the eligibility determination methods outlined in the ProviderOne

Billing and Resource Guide to check on the client’s medical eligibility.

Ask to receive confirmation of the client’s eligibility status at the time the

application is approved. If the client is not approved for a program which covers

hospice services, ask for the case to be reviewed or considered for a different

program.

Once the hospice agency receives confirmation of a client’s eligibility, the hospice

agency must resubmit HCA’s HCA/Medicaid Hospice Notification form, HCA 13-

746, by fax to: 360-725-1965.