Subject: Provider Resources and Tools for Appropriate Emergency Room Care

The Medicaid program of the Washington State Health Care Authority is implementing a policy that requires the Agency to determine the medical necessity of using the Emergency Room to provide health care services. This utilization review program will focus on the medical necessity of the place of service, not the medical necessity of the services provided.  An effective date will be announced later.  Please review the attached letter to learn about beneficial resources and tools that will assist Emergency Rooms, Emergency Room Physicians and Primary Care Providers when caring for clients who seek treatment for visits considered “not medically necessary in the ER setting.”  HCA strongly encourages you to learn more about the programs detailed in the letter.  Case Management and Emergency Department Information Exchange (EDIE) are among several tools the Agency is requesting hospitals and providers use for assessing medical necessity.

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NOTE: Please do not reply directly to this Listserv message. If you have feedback or questions, please select one of the email options above or visit the HCA website at http://hrsa.dshs.wa.gov/contact/default.aspx that way your message can be delivered to the appropriate staff.

JD-JD