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• The date and time the offender returned to your facility (if applicable) <br />Please note that if ANY hospitalization results in an inpatient event the Department, if properly notified, <br />will apply for Medicaid coverage under the Affordable Care Act and the County/Violator Facility will not <br />be billed for qualifying services. However, the County/Violator Facility must notify the Department of the <br />hospitalization and follow the emergency notification and/or pre -authorization process so that a Medicaid <br />application can be initiated for the event. <br />The Department is not obligated to reimburse the County/Violator Facility for medical care or treatment <br />provided to a Department Offender without the Department's pre -authorization or notification within the <br />timeframe specified in the contract. <br />Pre -authorization requests for extraordinary medical care including pertinent medical records and other <br />supporting documentation are faxed to the Utilization Management Office at (360) 586-9060. <br />The Department's Utilization Management Office will be available via telephone to assist staff 24 hours a <br />day and 7 days per week. <br />• From 8 a.m. - 4:30 p.m. Monday — Friday (except holidays), the Nurse Desk is available at <br />NurseDesk@docl.wa.gov or (360) 725-8733. <br />• After normal business hours and during holidays, please call (360) 725-8733. The call will forward <br />to the on-call UM Nurse. <br />If authorization for extraordinary medical care is denied, the practitioner may appeal the Department's <br />decision by submitting a written request and supporting documentation to DOC via email at <br />DOCHOMedicalRAB@DOC1.wa.gov <br />Pharmaceuticals and Non -Formulary Requests <br />Consistent with the medication continuation practice at DOC Reception Centers, DOC Contracted Violator <br />Facilities are authorized to receive reimbursement for Non -formulary or Restricted Formulary <br />prescriptions for up to 30 days for general medical medications and 60 days for mental health medications <br />provided to patients returning to custody due to a violation. However, the Department still encourages <br />Contracted Violator Facilities to use Formulary medications whenever possible. Over-the-counter (OTC) <br />medications and/or medical supplies are not reimbursable items. <br />For any single prescription that is expected to exceed $2500.00 per month, notification to the Department's <br />Utilization Management Office (Nurse Desk) is required. <br />Any questions related to medication reimbursement may be directed to the Nurse Desk at <br />NurseDesk@docl.wa.gov or (360) 725-8733. <br />Medical Billing <br />It is the responsibility of the billing County/Violator Facility to process payment for all bills prior to sending <br />them to the Department for reimbursement. However, if the County/Violator facility is unable to make <br />payment for direct billings, you may send a written request to the Department to process payment on the <br />behalf of the County/ Violator Facility can be submitted by fax (360) 586-1320 or email to <br />DOCHOMedicalRAB@DOCI.WA.GOV. Please include a copy of the bill with the request. The Department <br />will respond to written requests for assistance with payment of direct billings within seven (7) business <br />days of receipt. Please do not instruct the billing entity to bill the Department directly. <br />State of Washington K9561(6) Page 3 of 5 <br />Department of Corrections Attachment B-1 <br />