MedicaidAdministrativeMedium impact
Billing for enteral nutrition with overlap in dates of service
Washington Apple Health·WA · Gastroenterology, Family Medicine, Internal Medicine +1 more·Provider Alert
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Washington State Medicaid (Apple Health) now allows up to a 10-day overlap in dates of service for enteral nutrition refill claims when supplies are delivered/shipped before the client exhausts their current supply. This change addresses billing issues that previously occurred when nutrition supplies arrived early.
Action Required
By September 1, 2022: Billing team must update enteral nutrition billing procedures to allow up to 10-day overlap in dates of service for refill claims. Review and update billing system rules to prevent automatic denials of overlapping enteral nutrition claims. Ensure staff understand this applies only to refills delivered before supply exhaustion.