Medical providers and spenddown information
When spenddown is met and benefits authorized, notify the medical service providers affected by spenddown. Those whose bills remain the responsibility of the individual may continue to pursue collection for those bills.
Those provider bills which will be covered by the ProviderOne Card need to be billed to the Medicaid program, and the provider must cease billing the individual for those covered services.
The agency is authorized to release spenddown information to providers without a signed release of information form if it is information necessary for the provider to correctly bill HCA. This information includes: The amount of the spenddown assigned to their bill (if the bill is a split bill) The specific expenses and dollar amounts of their bill(s) that were used The total dollar amount of the spenddown liability The balance of spenddown remaining to be met.
If providers have questions related to spenddown for individuals who are pregnant or about children, refer them to the Medical Assistance Customer Service Center provider line toll free at 1-800-562-3022.
For other individuals on spenddown, refer them to the DSHS Specialty Unit toll free at 1-877-501-2233.