How we work. The links to these webinars, the waiver form, and an FAQ on the paperless policy can be accessed below: Use the provider billing guides and rates and fee schedules as companions to the billing and resource guide. Due to COVID-19, HCA’s lobby is closed. 3. 6. Review our new provider next steps. Recruitment. Verify you are an eligible provider. Download our instructions for adding Billing Type and Available Agencies in ProviderOne. Learn more about your customer service options. EVV Implementation Plan 2.1. Learn about changes to rates and updates to our billing guides. By 2019, nearly 600,000 new enrollees were receiving Apple Health for Adults coverage. Respond to provider requests for more step-by-step reference materials for ProviderOne. Bill in a timely fashion. Medical Nutrition Therapy fee schedule (2020-10-01) PDF. This guide supersedes all Prosthetic & Orthotic Devices Medicaid Provider Guides (MPGs) published by the Medicaid Program of the Health Care Authority (the Agency). Technology selection. About this guide . Medical Assistance Customer Service Center (MACSC)Online: Web formPhone: 1-800-562-3022, Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Contact us. How to use this guide. The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: Find client eligibility for services. Note: The Department now reissues the entire billing manual when making updates, rather than just a page … Public disclosure notification: Please note that all messages sent via GovDelivery are subject to public disclosure, as are the names and email addresses of those who sign up for email notifications. To find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. Recruitment. A Billing Instruction . Get Provider billing guide . This application process is for licensed health care professionals who wish to enroll with the Health Care Authority (HCA) as a performing provider practicing under a group or facility. Evidence report. Box 45530 • Olympia, WA 98504-5530. Health Technology Clinical Committee. Healthier Washington . The Nonbilling applications are for providers who are providing services to Apple Health (Medicaid) clients under a Managed Care Entity or Behavioral Health Organization (not under the fee-for-service Apple Health program) -or- providers enrolling for the sole purpose of becoming an ordering, referring, prescribing provider. Washington Healthplanfinder for MAGI Medicaid at (855) 923-4633 Monday through Friday 7:30 AM to 5:30 PM. Notice: If you are looking for Apple Health (Medicaid) client forms and publications, please visit our Free or low-cost forms library. The effective date and revision history are now Washington State Health Care Authority. States can use a managed care delivery system by getting a state plan amendment approved by CMS. PDF download: Billing Guide – Washington State Health Care Authority. Provider Guide – Washington State Health Care Authority. Interested in becoming an Apple Health (Medicaid) provider or need to find out if you are enrolled? The agency's Provider Relations team hosted two webinars focused on billing electronically through the ProviderOne portal to assist those providers who have not transitioned to electronic billing. Health technology reviews. About this Publication . Group practice This application process is for licensed health care professionals enrolling with the Health Care Authority (HCA) as: All billing providers must complete and sign a Core Provider Agreement and other required documents with the agency. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options, Use interactive voice response (IVR) to verify eligibility, Verifying eligibility using a magnetic card reader or MEV service, Casualty claims and health insurance claims, Instructions to fill out the General Information for Authorization Request form, Medicare crossover claim payment methodology, Direct Data Entry (DDE) webinar for billing dental claims, Direct Data Entry (DDE) webinar for billing professional claims, How to resubmit a paper claim using ProviderOne, Professional rates, fee schedules, and billing guides, Insurance company carrier codes (July 2020), Website feedback: Tell us how we’re doing. Services and/or equipment related to any of the programs listed below must be billed using their Coverage decision and meeting. The first step is to submit an attestation – Washington State Health Care Authority form 13- 0017 – to become an approved collaborative care provider for UnitedHealthcare Community Plan members. Jul 1, 2016 … State for Medicaid, the children's health insurance program (CHIP), and … To download and print agency provider notices and billing guides, … Provider Guide – Washington State Health Care Authority. Medical Nutrition Therapy [WAC 388-550-6300] July 1, 2011 . How we work. The following enrollment manuals provide step-by-step instructions for completing your application within ProviderOne. About this Guide . Nursing Facilities [Chapter 388-96 WAC] May 15, 2013 . October 2018. Key questions. Receive accurate payments for covered services. Use our enrollment manuals to complete your enrollment in the ProviderOne application. WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-90 (Sep. 2020). What is Washington Apple Health (Medicaid)?. A Billing Instruction . School Based Services. 2019). Tracking success. A Billing Instruction . By 2019, our intent is that the advancement of purchasing towards fully. What we're working on . Phone: 1-800-562-3022, ext. Use this chart to match the provider types above with the enrollment type options in ProviderOne. Washington Medicaid Provider Manual. Topic selection. Respond to provider requests Health Care Authority Medicaid Provider Guide Chemical-Using Pregnant (CUP) Women Program -5330701 WAC 388 0730] A Billing Instruction . Clinical experts. Medical Nutrition Therapy fee schedule (2020-10-01) Provider billing guide. Decision complete. (Accessed Aug. 2019). They are presented here for your convenience. Committee members. Strengthen the current instructions that apply to nearly all types of providers. Washington’s EVV process for Home Care Agencies: To comply with Cures Act requirements, and to allow the State to conduct efficient quality … Evidence report. Your contact information is used to deliver requested updates or to access your subscriber preferences. Phones are open on Tuesdays and Thursdays from 7:30 a.m. to 4:30 p.m. (closed from 12:00 p.m. to 1:00 p.m.). CPT® is a trademark of the American Medical Association. 16137Phones are open: Tuesdays and Thursdays from 7:30 a.m. to 4:30 p.m. (Closed from noon to 1 p.m.)Phones are closed: Mondays, Wednesdays, and Fridays.Email: providerenrollment@hca.wa.gov, Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Health technology reviews . Washington State Medicaid HIT plan. View the complete guide The guide is intended to: Strengthen the current instructions that apply to nearly all types of providers. Technology selection. Washington State Medicaid HIT plan. This guide published by Health Care Authority (the Agency), supersedes all previous Agency Physician-Related Services/HealthCare Professional Medicaid Provider Guides published by the Agency. This guide supersedes all previous Agency Dental Medicaid Provider Guides and is published by the Medicaid Program of the Washington State Health Care Authority. This publication supersedes all previous Agency Tribal Health Program Billing Instructions published by the Washington State Health Care Authority. What we're working on. You will use these regularly as you submit your claims. Providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically. (Accessed Sep. 2020). Reason for Change Effective Date Page No. Key questions. To download and print the Agency’s provider notices and Medicaid provider guides, go to the Agency’s website at http://hrsa.dshs.wa.gov (click the Medicaid Provider Guides and Provider Notices link). P.O. To download and print Agency Provider Notices and Medicaid Provider Guides, go to the Agency website at http://hrsa.dshs.wa.gov (click the Medicaid Provider Guides and Provider Notices link). 2. Where can I get help completing my application? Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 92 (Jul. Complete the supplemental paperwork for your provider type. Licensed health care groups and facilities (including suppliers and contractors of service). Decision complete. Appendix A - Use interactive voice response (IVR) to verify eligibility, Appendix B - Verifying eligibility using a magnetic card reader or MEV service, Appendix C - Managed care organizations (MCOs), Appendix D - Casualty claims and health insurance claims, Appendix F - Instructions to fill out the General Information for Authorization Request form, Appendix G - How to check status of an authorization, Appendix H - Cover sheets for backup documentation, Appendix J - Medicare crossover claim payment methodology, Appendix K - Checking claim status with IVR. Washington State Medicaid Transformation Waiver … – Medicaid.gov. 2. Washington State Medicaid 835 Health Care Payment/Advice HIPAA Transaction Standard Companion Guide Refers to the ASC X12N 835 (Version 005010X221A1) CORE v5010 Companion Guide: Version 1.0 March 2015 . Health Care Authority - Apple Health (Medicaid) Manual Revised December 11, 2014 Due to implementation of the Affordable Care Act (ACA), medical WAC’s and clarifying information can now be found in the Apple Health (Medicaid) Manual . Reset filters. Washington State Health Care Authority Medicaid Provider Guide . Receive accurate payments for covered services. The following programs have individual MPGs: Wheelchairs & Durable Medical Equipment and Supplies Medicaid Provider Guide Medical Nutrition Medicaid Provider Guide Tribal Health Program . Interested? Topic selection. The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: The appendixes below are included in the complete guide. On October 1, 2016, we implemented a paperless billing policy where all Apple Health (Medicaid) providers (excluding Tribal billing offices) are required to submit electronic claims for Apple Health (Medicaid) services. Clinical experts. Follow our guidelines to prepare for the enrollment process. Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. Washington State Health Care Authority Medicaid Provider Guide . Determine your provider type for enrollment (below). Healthier Washington is a multi-sector partnership working to improve health, transform care … Due to COVID-19, HCA’s lobby is closed. Billing Guide – Washington State Health Care Authority. This publication supersedes all previous Nondurable Medical Supplies and Equipment Medicaid Provider Guide published by the Medicaid Program of the Health Care Authority (the Agency). instructions for adding Billing Type and Available Agencies in ProviderOne, Website feedback: Tell us how we’re doing. Committee members. The group or facility must be enrolled with HCA, and have a Core Provider Agreement with the agency. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options. The state plan preprint includes information such as the types of entities that will be used and what groups of people will be enrolled. Subject Change Provider Notice 12-111 January 1, 2013 Page 22 Limited Visual Oral Assessment 4. Then use the ProviderOne billing and claims system to complete your enrollment application. This guide only pertains to Medicaid coverage. Topic . Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. Stay informed! For best results, bookmark this page so that you are always using the most up-to-date version of the guide. Tribal Health, Health care professional practicing under a group or facility. Which enrollment type should I select in the ProviderOne application? Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. Eligibility for services related to any of the Guide WA EVV Implementation Guide for Home Agencies... 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