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Attachment B Pre-authorization and Medical Billing Instructions The County, City, or Tribal entity (hereinafter Contractor) must obtain pre-authorization through the Department's Utilization Management Office for all health care beyond what is normally provided to Conh·actor's inmates. This includes, but is not limited to, notification of Deparhnent offenders who are on specialty/high cost medications for long-term or chronic conditions such as Hepatitis C, HIV, Multiple Sclerosis or any other condition that requires the consistent administration of m_edications during the Department offender's confinement. In the case of an emergency, when pre-authorization is not feasible, the Contractor must notify the Department's Utilization Management Office as soon as possible, but no later than 4 hours after transporting the Department Offender to an emergency room or other medical facility and before any hospital admission. The following information must be included with notifications: • The date and time the Department offender left Contractor's facility because of the medical event; • The name of the hospital or medical facility; • The medical issue/reason for trip; and, • The date and time the offender returned to Contractor's facility, if applicable. Please note: If ANY hospitalization of a Department offender results in an inpatient event then the Department, if properly notified, will apply for Medicaid coverage under the Affordable Care Act and the Contractor will not be billed for qualifying services. However, the Contractor must notify the Department of the hospitalization and follow the emergency notification and pre-authorization process so that a Medicaid application can be initiated for the event. The Department must open a claim within 90 days of the date of service. The Department is not obligated to reimburse the Contractor for medical care or treatment provided to a Department offender without the Department's pre-authorization or notification within the 4 hour timeframe specified in the contract. Pre-authorization requests for extraordinary medical care, including pertinent medical records, and other supporting documentation, must be faxed to the Department's Utilization Management Office at (360) 586-9060. The Department's Utilization Management Office is available via telephone to assist Contractor 24 hours a day and 7 days per week. State of Washington Department of Corrections K9561 (4) Page 20 of25 158362