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Attachment B <br />Pre -authorization and Medical Billing Instructions <br />The County, City, or Tribal entity (hereinafter Contractor) must obtain pre -authorization <br />through the Department's Utilization Management Office for all health care beyond what is <br />normally provided to Contractor's inmates. This includes, but is not limited to, notification of <br />Department offenders who are on specialty/high. cost medications for long-term or chronic <br />conditions such as Hepatitis C, HIV, Multiple Sclerosis or any other condition that requires the <br />consistent administration of medications during the Department offender's confinement. <br />In the case of an emergency, when, pre -authorization is not feasible, the Contractor must notify <br />the Department's Utilization Management Office as soon as possible, but .no later than 4 hours <br />after transporting the Department Offender to an emergency room or other medical facility and <br />before any hospital admission. <br />The following information must be included with notifications: <br />• The date and time the Department offender left Contractor's facility because of the <br />medical event; <br />• The name of the hospital or medical facility; <br />• The medical issu.e/reason .for trip; and, <br />• The date and time the offender returned to Contractor's facility, if applicable. <br />Please note: If ANY hospitalization of a Department offender results in an inpatient event then <br />the Department, if properly notified, will apply for Medicaid coverage under the Affordable <br />Care Act and the Contractor will not be billed for qualifying services. However, the Contractor <br />must notify the Department of the hospitalization and follow the emergency notification and <br />pre -authorization process so that a Medicaid application can be initiated for the event. The <br />Department must open a claim within 90 days of the date of service. <br />The Department is not obligated to reimburse the Contractor for medical care or treatment <br />provided to a Department offender without the Department's pre -authorization or notification <br />within the 4 hour timeframe specified in the contract. <br />Pre -authorization requests for extraordinary medical care, including pertinent medical records, <br />and other supporting documentation, must be faxed to the Department's Utilization <br />Management Office at (360) 586-9060. <br />The Department's Utilization Management Office .is available via telephone to assist Contractor <br />24 hours a day and 7 days per week. <br />State of Washington K9561(4) Page 20 of 25 <br />Department of Corrections 158362 <br />