Information For Providers

These resources are for health care providers. They contain HIV prevention messages and information. They may not be appropriate for all audiences.

PrEP DAP Contracting for Medical & Lab Services

If you are a provider in Washington State who is prescribing PrEP to people at high risk for HIV acquisition, you can now contract with Department of Health PrEP DAP for us to pay you for PrEP DAP enrollees portion of their medical and lab costs (up to our maximum allowed).

To become a contracted provider with PrEP DAP, you will need to submit a contract to the Department of Health Early Intervention Program. The contract packet (below) includes instructions and all submission forms necessary for a complete submission.

Please be sure to mark “PrEP DAP” on the contract. If you are also providing services to people living with HIV, select “Both” to be contracted with the HIV Client Services AIDS Drug Assistance Program (ADAP/EIP).

DOH Contract Packet (PDF)

Submit the completed packet to the Department of Health using one of the following methods:

Mail: Washington State Department of Health
HIV Client Services Early Intervention Program
PO BOX 47841
Olympia WA 98504-7841

Fax: 360-664-2216

Email: EIP.ClaimsPayments@doh.wa.gov

Documents for Contracted Providers

PrEP DAP Provider Billing Guide (PDF)
This document is for contracted PrEP DAP providers to use as a guide for submitting claims.

PrEP DAP List of Covered Services, 4/2019 - 3/2020 (PDF)

Our PrEP DAP Schedule of Coverage and Maximum Allowances shows everything we cover. The max allowed column shows how much we will pay the contracted provider.

PrEP DAP Explanation of Benefit Code Definitions (PDF)
This document is for providers to understand the EOB codes listed on claims submitted and adjudicated.

PrEP DAP Benefit Exception Request (PDF)
This is used for requesting an exception for PrEP DAP to cover a service that is not covered. Submission of this form is not a guarantee of exception approval. The submission will be reviewed by program and a determination will be sent to the requesting provider within 10 business days of receipt.

PrEP DAP Formulary (PDF) - new medications added
With the addition of medical services, we have added more medications to our formulary. Use the PrEP DAP Formulary (PDF) to see the medications we cover.

PrEP Prescribing Guidelines and Recommendations

Pre-Exposure Prophylaxis Clinical Prescribing Guidelines - 2017 Update (PDF)
The CDC recommended PrEP Clinical Prescribing Guidelines for providers were updated in 2017 (Published Online March 2018). In the updated guidelines, you will find the updates highlighted in yellow.

PrEP Implementation Guidelines (October 2015) (Public Health Seattle & King County Website) (PDF)
Department of Health and Public Health Seattle & King County collaboratively developed these guidelines to provide guidance on defining priority populations for PrEP initiation in Washington State.

NASTAD Billing and Coding Guide for HIV Prevention (PDF) (April 2016)
This coding guide will describe procedure (CPT®) and diagnosis code (International Classification of Diseases, 10th revision, Clinical Modification, ICD-10) that health care professionals can use when submitting claims for reimbursement for HIV Prevention Services, including PrEP.

HIV Testing in non-clinical settings (CDC webpage)
Discussion of testing venues and CDC Guidance for HIV testing in non-clinical settings.

HIV testing in clinical settings (CDC webpage)
CDC recommendations for clinician screening of adolescents and adults ages 15 to 65 years for HIV infection.

Washington State Nonclinical Setting HIV Testing Guidelines (PDF)
The purpose of this Washington State Nonclinical Setting HIV Testing Guidelines manual is to familiarize HIV testing providers working in nonclinical settings with key testing policies and procedures that impact HIV testing services and deliverables.

Washington State STD Screening Guidelines (PDF)
Attached are the Washington State STD Screening Guidelines from the Washington State Clinical Laboratory Advisory Council. This Guideline was updated March 2018.

CDC STD & HIV Screening Recommendations (CDC Webpage)
The CDC STD & HIV Screening Recommendations for Health Care Providers.

CDC STD Guidelines & Recommendations (CDC Webpage)
The CDC STD Treatment Guidelines (2015) for Health Care Providers.

PEP (Post Exposure Prophylaxis)

PEP is a 28 day treatment regimen for people who are HIV-negative but may have had an exposure to HIV through sex, injection drug use, or other exposures. PEP can reduce the chance of becoming HIV-positive.

  • Treatment must start within 72 hours of the exposure so timing is important.
  • PEP candidates must be seen by a provider who can prescribe them PEP medication. They can go to their health care provider, an Urgent Care clinic, local Health Department or Emergency Room.
  • Once a person has completed their 28 day treatment, they should discuss PrEP with their provider.

PEP 101 (PDF)

CDC PEP Basics (CDC Webpage)

CDC Nonoccupational PEP Guidelines (nPEP) (PDF)
Guidelines from the Center for Disease Control & Prevention and US Department of Health & Human Services on nPEP.

CDC Guidelines & Recommendations for Occupational PEP (oPEP) (CDC Webpage)
Updated US Public Health Guidelines for the management of occupational exposures to HIV and recommendations for oPEP.