Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-544 - Vision care
VISION CARE - CLIENTS TWENTY YEARS OF AGE AND YOUNGER
Section 182-544-0560 - Vision care - Authorization

(1) The medicaid agency requires providers to obtain authorization for covered vision care services as required in this chapter.

(2) Authorization requirements in this chapter are not a denial of service.

(3) When a service requires authorization, the provider must properly request authorization in accordance with the agency's rules and billing instructions.

(4) When authorization is not properly requested, the agency rejects and returns the request to the provider for further action. The agency does not consider the rejection of the request to be a denial of service.

(5) The agency's authorization of service(s) does not necessarily guarantee payment.

(6) The agency evaluates requests for authorization of covered vision care services that exceed limitations in this chapter on a case-by-case basis in accordance with WAC 182-501-0169.

(7) The agency may recoup any payment made to a provider if the agency later determines that the service was not properly authorized or did not meet the EPA criteria Refer to WAC 182-502-0100.