EIP/ADAP Documents

Application for EIP, July 2017 - English (PDF)
Application for EIP Program.

Application for EIP - Spanish, July 2017 (PDF)
Application for EIP Program.

Application Instructions - English (PDF)
Application Instructions for EIP Program.

EIP Brochure (PDF)
Information about EIP Program.

EIP Brochure - Spanish (PDF)
Information about EIP Program.

HIV and Health Status Information (PDF)
Collects information on HIV and health status.

HIV and Health Status Information - Spanish (PDF)
Collects information on HIV and health status.

Case Management

HIV Community Services Provider Manual - 2021 (PDF)
Overview of Washington's HIV Community Services programs. Includes what is expected of providers receiving DOH funding for serving persons living with HIV or persons at high risk regarding standards of care, minimum requirements around policy, process, and reporting.

Covered Services and EIP Eligibility Guides

Dental Covered Services (PDF)
List of dental covered services.

Medical Schedule of Coverage and Maximum Allowances (PDF)
List of medical services and the maximum amount covered for those services.

FAQ for Medical Bills (PDF)
What to do if you receive a medical bill.

Drug List (Formulary) - Ramsell Corp website (you will leave this website )
Provides list of drugs EIP will pay for - click on 'What Drugs Are Covered?' under Frequently Asked Questions.

Ramsell Card (PDF)
Ramsell Pharmacy Benefit Prescription Drug Card Instructions.

Ramsell Reimbursement Form (PDF)
Reimbursement form for out-of-pocket medication co-pay expenses.

Eligibility Exception Form (PDF)
Request exception to policy for eligibility, medication, and premium assistance.

PrEP DAP

PrEP DAP documents moved to the HIV Prevention Documents section.

Providers

EIP Provider Contract (PDF)

Provider Resources

Billing Code Information (PDF)
Message code (EOB) description and instructions.

Benefit Exception Request (DOCX)
Form for medically necessary EIP benefit exceptions.

Provider Billing and Resource Guide (PDF)
Guide to billing and policies for EIP Contracted Providers

Provider Portal Instructions (PDF)
Detailed instructions on how to access the Provider Portal for contracted Providers. Gives access to payment remittances, eligibility and submitting authorizations.

Reports

Washington Statewide Coordinated Statement of Need 2017-2021 (PDF)
Current incidence and prevalence, description of prevention and service needs, barriers to care and planning for future HIV prevention activities.