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PDFWAC 182-537-0600

School district requirements for billing and payment.

To receive payment from the medicaid agency for providing school-based health care services (SBHS) to eligible children, a school district must:
(1) Enroll as a billing provider in ProviderOne and have a current, signed core provider agreement (CPA) with the agency.
(2) Have a current, signed, and executed SBHS contract with the agency.
(3) Meet the applicable requirements in chapter 182-502 WAC.
(4) Comply with the applicable requirements in the agency's current, published ProviderOne billing and resource guide.
(5) Bill according to the agency's current SBHS billing guide and the SBHS fee schedule.
(6) Comply with the intergovernmental transfer (IGT) process. The school district must provide its local match to the agency within one hundred twenty days of the invoice date.
(a) If local match is not received within one hundred twenty days of the invoice date, the agency will deny claims.
(b) School districts may resubmit denied claims within twenty-four months from the date of service under WAC 182-502-0150.
(7) Provide only early intervention or health care-related services identified through a current individualized education program (IEP) or individualized family service plan (IFSP).
(8) Use only licensed health care providers or nonlicensed people practicing under the supervision of a licensed provider under WAC 182-537-0350.
(9) Enroll licensed health care providers as servicing providers under the school district's ProviderOne account, and ensure providers have their own national provider identifier (NPI) number.
(10) Meet documentation requirements described in WAC 182-537-0700.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 20-14-062, § 182-537-0600, filed 6/26/20, effective 7/27/20; WSR 19-04-095, § 182-537-0600, filed 2/5/19, effective 3/8/19; WSR 16-07-141, § 182-537-0600, filed 3/23/16, effective 4/23/16. Statutory Authority: RCW 41.05.021, 34 C.F.R. 300.154(d), and chapter 182-502 WAC. WSR 13-21-079, § 182-537-0600, filed 10/17/13, effective 11/17/13. Statutory Authority: RCW 41.05.021. WSR 13-05-017, § 182-537-0600, filed 2/7/13, effective 3/10/13. WSR 11-14-075, recodified as § 182-537-0600, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500, and 42 C.F.R. 440.110. WSR 09-07-004, § 388-537-0600, filed 3/4/09, effective 4/4/09.]
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