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Billing for Patient Care Services Resource Center
ESSB 5557 - Washington's Recognition of Pharmacists as Patient Care Providers
The passage of SB 5557 has created a great deal of excitement and questions. The WSPA is working hard on your behalf to help answer your questions and provider resources to assist pharmacists in their pursuit to provider status and inclusion in health plan provider networks.
The WSPA Pharmacists as Providers Page includes the latest information to to help you:
If you have questions about accessing the page or being a WSPA member please email us at askwsparx.org or call 425-228-7171 and select 0. This page is a members only page, and will require you to login to the website. Our members help to support important work such as this!
How to Begin Prepare to Bill for Patient Care Services:
1. Every Pharmacist Needs Their Own National Provider Identification (NPI)
Health care providers that are considered "covered health care providers" under HIPAA are required to obtain a NPI number. A covered health care provider is a health care provider who transmits any health information in electronic form between two parties to carry out financial or administrative activities related to health care. Pharmacists and pharmacies are included as health care providers and are eligible to apply for an NPI number. Pharmacies and pharmacists who transmit health information in an electronic format must obtain an NPI number. Provider NPI’s will be separate from a pharmacy’s NPI number. For more information or to apply for your NPI, please visit the National Plan and Provider Enumeration System (NPPES) https://nppes.cms.hhs.gov/NPPES/Welcome.do
To become credentialed, medical insurance companies mandate that each health care provider is covered under professional liability insurance. WSPA strongly believes that every practicing pharmacist should carry their own liability insurance in addition to that provided through their employer. Liability insurance is the only protection against a personal malpractice claim you may have. Individuals should understand that personal umbrella policies often exclude professional activities and malpractice is a personal claim against the individual. If a claim is filed, the insurance company for your employer may choose to accept fault and settle, but you may not be willing to accept fault against you – and therefore may need your own protection. WSPA recommends Pharmacist Mutual Insurance because the company covers the entire scope of the practice of pharmacy including compounding, work under a collaborative agreement and medication management. To apply for insurance, visit https://apps.phmic.com/phl/. Insurance for an employed individual is $144 per year.
3. Get Credentialed.
WSPA's Contracting and Credentialing Workgroup is developing best practices and guidance for how to begin this process with the health insurance carriers. Check out the WSPA Contracting and Credentialing Resource Center.
4. Identify Covered Billable Services and Use the Appropriate Codes
What services could pharmacists provide and bill for?
5) Submit Bill
The WSPA's Health Infrastructure Technology Workgroup is compiling resources for pharmacists to understand the systems they may need as Medical Providers to check eligibility, submit claims and document.
Additional News and Resources
August 10, 2016 Medical Billing for Pharmacy Professionals Workshop at the Marriott Sea Tac Airport.
ASHP Spotlight on Pharmacist Billing for Ambulatory Pharmacy Patient Care Services in a Physician-Based Clinic and Other Non-Hospital-Based Environments - FAQ