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Get Started Billing as a Medical Provider

With the passage of WA SB 5557, pharmacists in Washington have a tremendous opportunity – we can bill for services. It’s a law we have fought for decades to achieve and requires health plans to include pharmacists in their provider networks. By treating pharmacists equal to other healthcare providers, the law opens the door for pharmacists to provide and bill for patient care services within their scope of practice. This is the first provider-status victory of its kind in the country!

 

Billing a medical claim for a service is very different than billing a pharmacy claim  for a product to a PBM. The WSPA has done work to help demystify this new world. Let us help you utilize the full extent of your scope of practice and start billing for the patient care you provide.

 

First Step: Enroll in Health Plan Provider Networks

In order to bill a patient's health insurance for the patient care services you provide, you must contract with the health plans that cover your patients. This is the same process for all healthcare providers.
The WSPA has an extensive resource center to identify the health plan provider networks and walk you through the enrollment, contracting and credentialing processes.

WSPA Contracting and Credentialing Resource Center (members)

 

Second Step: Identify Coding, Billing and Documentation for Specific Services

Much of the care pharmacists provide may be reimbursed using standard billing codes available to all medical providers. The Billing for Patient Care Services Page discussed covered services and billing code selection resources.  

 

Third Step: Fill Technology Gaps

Technology has rapidly evolved to meet the needs of pharmacists providing patient care and billing for services. The Billing for Patient Care Technology Page provides IT solutions. The WSPA has created resources to help you bill a health plan for medical services.

 

 

Fourth Step: Provide Care and Submit Medical Claims

After you are in the health plan provider networks, you can start billing for the covered services you provide. Medical billing can be complicated with many compliance nuances. CHOICE has made it easy to learn with our Medical Billing Continuing Education Sessions. Take one or take them all, these break down what you should know about medical billing into bite sized pieces!  Ambulatory and Community Pharmacists across Washington are billing for patient care successfully!


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