Wash. HCA Hospice Services Billing Guide, Resources Available

Topic Contact Information

Who do I contact if I have

questions regarding hospice

or Pediatric Palliative Care

(PPC) Case

Management/Coordination

policies or need information

on notification requirements?

• Billing questions 800-562-3022 (customer service line for claims)

• HCA - Clinical Quality and Care Transformation

PO Box 45535

Olympia, WA 98504-5506

Who do I contact if I have

questions regarding

medications not related to

the hospice diagnosis?

Pharmacy only providers

800-848-2842

All other providers

800-562-3022

How do I obtain HCA’s

Hospice program forms?

View and download the HCA/Medicaid Hospice Notification form,

HCA 13-746, and the Pediatric Palliative Care (PPC) Referral and 5 -

Day Notification form, HCA 13-752. See Where can I download HCA

forms?

Where is the Hospice Services

fee schedule?

See HCA’s Hospice Fee Schedule

How do I obtain prior

authorization or a limitation

extension?

For prior authorization or limitation extension, providers may submit

prior authorization requests online through direct data entry into

ProviderOne. See HCA’s prior authorization webpage for details.

Providers may also fax requests to 866-668-1214 along with the

following:

• A completed, typed General Information for Authorization form,

HCA 13-835. This request form must be the initial page when you

submit your request.

• A completed Hospice (including PPC) Authorization Request

form, HCA 13-848, and all the documentation listed on this form

and any other medical justification.

See Where can I download HCA forms?

For more information on requesting authorization, see HCA’s

ProviderOne Billing and Resource Guide.

How do I find out where my

local Community Services

Office (CSO) is located?

See Community Services Office

Topic Contact Information

How do I find out where my

local Home and Community

Services (HCS) office is

located?

See Home and Community Services