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. 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. Verify you are an eligible provider. Technology selection. 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). 1. Tribal Health Program . WASHINGTON STATE MEDICAID CORE COMPANION GUIDE … Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. Licensed health care groups and facilities (including suppliers and contractors of service). What we're working on. Note: The Department now reissues the entire billing manual when making updates, rather than just a page … Aug 25, 2015 … Benefit Specifications and Provider Qualifications Form – Supportive ….. deployment of common statewide performance measures to guide health care …. What is Washington Apple Health (Medicaid)?. For best results, bookmark this page so that you are always using the most up-to-date version of the guide. Key questions. Committee members. 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: [email protected], 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. Group practice By 2019, nearly 600,000 new enrollees were receiving Apple Health for Adults coverage. P.O. Use this chart to match the provider types above with the enrollment type options in ProviderOne. 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.). 3. This publication supersedes all previous Agency Tribal Health Program Billing Instructions published by the Washington State Health Care Authority. Evidence report. 6. Review our new provider next steps. School Based Services. A Billing Instruction . WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-90 (Sep. 2020). Health technology reviews. Washington Medicaid Provider Manual. Contact us. CPT® is a trademark of the American Medical Association. Search . This guide only pertains to Medicaid coverage. Coverage decision and meeting. 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 Technology Assessment. Respond to provider requests For information about public health precautions, infection control guidance and state guidelines for resuming elective and non-emergent services, please refer to the Public Health Division’s COVID-19 page for health care providers and partners. 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. EVV Implementation Plan 2.1. How we work. Health Care Authority Medicaid Provider Guide . What we're working on . Your contact information is used to deliver requested updates or to access your subscriber preferences. (Accessed Sep. 2020). Box 45531 Olympia, WA 98504. Due to COVID-19, HCA’s lobby is closed. View MAC memo for rate changes effective February 1, 2021. Health Technology Assessment. 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. The state plan preprint includes information such as the types of entities that will be used and what groups of people will be enrolled. What Has Changed? Determine your provider type for enrollment (below). Washington State Health Care Authority Medicaid Provider Guide . Evidence report. About this guide . To find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. Washington State Health Care Authority at (800) 562-3022; The Community Services Office for Classic Medicaid: By phone at (877) 501-2233 Monday through Friday 8 AM to 5 PM; By email [email protected]; By mail at: P.O. 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. Where can I get help completing my application? Stay informed! Recruitment. Topic selection. Medical Nutrition Therapy fee schedule (2020-10-01) PDF. Dear Provider, Washington Apple Health (Medicaid), administered by the Health Care Authority (agency), will implement changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program. Jul 1, 2016 … State for Medicaid, the children's health insurance program (CHIP), and … To download and print agency provider notices and billing guides, … Medicaid Provider Billing Workshop – Washington State Health Care … Provide outreach and training for Washington. WA EVV Implementation Guide for Home Care Agencies Dated: February 3, 2020 5 2. Washington State Health Care Authority. 5. 2. Topic selection. 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. About this Publication . By 2019, our intent is that the advancement of purchasing towards fully. The Washington State Health Care Authority and UnitedHealthcare Community Plan are encouraging care providers to learn more about how they may integrate this model into their practice. Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. Apr 1, 2016 … Physician-Related Services/Health Care Professional Services. Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. The billing agent/clearinghouse application process is for a billing agent/clearinghouse (BA/CH) to be enrolled with Washington Apple Health (Medicaid) to ensure the flow of electronic data resulting from the submission and retrieval of HIPAA transactions can be tracked. Complete the supplemental paperwork for your provider type. States can use a managed care delivery system by getting a state plan amendment approved by CMS. 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. ) Women Program -5330701 WAC 388 0730 ] a Billing instruction )? you are already an Health. 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