# WAC 182-501-0163: WAC 182-501-0163. Health care coverage — Process for submitting a valid request for authorization > Washington · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0163 ## Section - **Citation:** WAC 182-501-0163 - **Heading:** WAC 182-501-0163. Health care coverage — Process for submitting a valid request for authorization - **Jurisdiction:** Washington - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Washington Administrative Code / Title 182 / Chapter 182-501 / Section 182-501-0163 ## Text (1) The medicaid agency requires providers to obtain authorization for certain health care services under this section, chapters 182-501 and 182-502 WAC, other applicable agency rules, current published agency billing instructions, and numbered memoranda. For the purposes of this section, health care services include treatment, equipment, related supplies, and drugs. (a) For health care services that require prior authorization (PA), a provider (as defined in WAC 182-500-0085 ) must submit a written, electronic, or telephonic request to the agency. To be a valid request for PA, the provider must send the request and follow the agency's current published program billing instructions, numbered memoranda, and any additional requirements in Washington Administrative Code (WAC) and Revised Code of Washington (RCW). (b) For expedited prior authorization (EPA), a provider must certify that the client's clinical condition meets the appropriate EPA criteria outlined in the agency's current published program billing instructions, numbered memoranda, and any additional requirements in WAC and RCW. The provider must use the agency-assigned EPA number when submitting a claim for payment to the agency. (c) The agency requires PA for covered health care services when the applicable EPA criteria are not met. (d) Upon request, a provider must send documentation to the agency showing how the client's condition meets the required criteria for PA or EPA. (2) Agency authorization requirements for covered health care services are not a denial of service. (3) The agency returns invalid requests to the provider and takes no further action unless the request for authorization is resubmitted. The return of an invalid request is not a denial of service. (4) Failure of a provider to request authorization for a health care service that requires it or a provider's failure to do so properly is not a denial of service. services are not a denial of service. (3) The agency returns invalid requests to the provider and takes no further action unless the request for authorization is resubmitted. The return of an invalid request is not a denial of service. (4) Failure of a provider to request authorization for a health care service that requires it or a provider's failure to do so properly is not a denial of service. (5) The agency's authorization of health care services does not guarantee payment. See WAC 182-501-0050 for other general requirements that must be satisfied before payment can be made for a health care service requested and authorized under this section. (6) The agency evaluates a request for authorization of a health care service that exceeds identified limitations on a case-by-case basis and under WAC 182-501-0169 . (7) The agency may recoup any payment made to a provider if the agency later determines the health care service was not properly authorized or did not meet EPA criteria. See chapters 182-502 and 182-502A WAC. ## Nearby sections - [WAC 182-501-0050 WAC 182-501-0050. Health care general coverage](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0050.md) - [WAC 182-501-0055 WAC 182-501-0055. Health care coverage — How the agency determines coverage of services for its health care programs using health technology assessments](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0055.md) - [WAC 182-501-0060 WAC 182-501-0060. Health care coverage — Program benefit packages — Scope of service categories](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0060.md) - [WAC 182-501-0065 WAC 182-501-0065. Health care coverage — Description of service categories](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0065.md) - [WAC 182-501-0070 WAC 182-501-0070. Health care coverage — Noncovered services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0070.md) - [WAC 182-501-0100 WAC 182-501-0100. Subrogation](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0100.md) - [WAC 182-501-0125 WAC 182-501-0125. Advance directives](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0125.md) - [WAC 182-501-0135 WAC 182-501-0135. Patient review and coordination (PRC)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0135.md) - [WAC 182-501-0160 WAC 182-501-0160. Exception to rule—Request for a noncovered health care service](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0160.md) - [WAC 182-501-0163 WAC 182-501-0163. Health care coverage — Process for submitting a valid request for authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0163.md) - [WAC 182-501-0165 WAC 182-501-0165. Medical and dental coverage — Fee-for-service (FFS) prior authorization — Determination process for payment](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0165.md) - [WAC 182-501-0169 WAC 182-501-0169. Health care coverage — Limitation extension](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0169.md) - [WAC 182-501-0175 WAC 182-501-0175. Medical care provided in bordering cities](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0175.md) - [WAC 182-501-0180 WAC 182-501-0180. Health care services provided outside the state of Washington — General provisions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0180.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0163. Check the current official text before relying on it. Not legal advice.