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�� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.44;i 3;.55;U 5;S.6;࢖ ;c.9;Ć ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.44;i 3;.55;U 5;S.6;࢖ ;c.9;Ć ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Page of Washington Apple HealthReferring Provider Tip SheetPer insurance requirementsall patients interested in weight loss surgery must be evaluated by a �� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.44;i 3;.55;U 5;S.6;࢖ ;c.9;Ć ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.44;i 3;.55;U 5;S.6;࢖ ;c.9;Ć ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Page of FAQQ: Who can evaluate and request Stage authorization?A: Patients may seek evaluation from their Primary Care Provider, other specialistor a Medical Weight Loss Bariatrician at the Center for Weight Loss & Wellness(CWLW). The evaluating/ requesting physician must agree to supervise the patient’s 6month diet.Patients who are referred to CWLW without Stage authorization in place are offered these options:Return to the referring physician for evaluation at which point the referral would be closed and reopened upon notification of authorization.Schedule an appo

intment with a CWLW bariatrician for evaluation.Q: How is Stage II authorization submitted?A: This varies by insurancemost have a planspecific formwhereas others require online submission(see tablebelow). If you are requesting Stage II authorization, please do not return forms and clinicaldocumentationto our office aswe are not able to submit it to the health planon behalf of another provider Health Plan Submission Type Notes Molina Healthy Options Fax Form Stage 2 - specific form United Community Healthy Options Online or Phone Request authorization for nutritional counselinguse CPT code 97802. Use notes section to indicate that the request is for Stage 2. United will review and refer to case management as necessary. Coordinated Care Fax Form Stage 2 - specific form CHPW Fax Form Stage 2 - specific form Amerigroup Fax Form Use outpatient prior authorization form. Under “Requested service” section, check box for “Other” and write in “Bariatric Program Stage 2.” Q: What is the referred to facility information?A: See below. Practice Name MultiCare Center for Weight Loss & Wellness NPI 1366556227 Address 2202 South Cedar, Suite 300, Tacoma, WA 98405 Phone 253 - 301 - 5331 Fax 253 - 572 - 9251 Q: Stage II was approvedwhat is next?A: pon authorization of Stage , the patient should consult with their bariatric surgeon immediately. This process has a strictdeadline and we will make every effort to schedule the consultation wi

thin these limitations. Please notify us as soon as possible after receiving authorizatioQ: Stage II was deniednow what? �� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.44;i 3;.55;U 5;S.6;࢖ ;c.9;Ć ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.44;i 3;.55;U 5;S.6;࢖ ;c.9;Ć ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Page of A: Stage is most often denied for not meeting policy criteria. If the physician feels bariatric surgery is necessary, a PeerPeer discussion can be scheduled,and an exception can be requested.If this is unsuccessful, normal appeal process can be followed.If Stage options are exhausted, the patient has the option to consider Medical (nonsurgical) Weight Loss as an alternative.Q: Is Medical(NonSurgicalWeight Loss a covered benefit?A: No. Specialist office visits with the diagnosis of obesity are covered but medical nutrition or preventive nutritional counseling therapies are not a covered benefit unless specifically authorized under the umbrella of Stage Patients in theMedical Weight Loss pathway mustworkwith a dietitian so these visitswillhave to be paidby the patient.MultiCare CWLW 2021 selfpay discount is 60%.If you have any questions or need further guidanceregardingto this process, please do not hesitate to call our office. Surgical Patient Care and Referral Coordinators can be reached at 2