Decision complete. instructions for adding Billing Type and Available Agencies in ProviderOne, Website feedback: Tell us how we’re doing. Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 92 (Jul. October 2018. View the complete guide The guide is intended to: Strengthen the current instructions that apply to nearly all types of providers. P.O. Strengthen the current instructions that apply to nearly all types of providers. About this Guide . Health technology reviews . Complete the supplemental paperwork for your provider type. About this guide . Fac/Agncy/Orgn/Inst Reason for Change Effective Date Page No. Sort by. Follow our guidelines to prepare for the enrollment process. 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. Determine your provider type for enrollment (below). Use this chart to match the provider types above with the enrollment type options in ProviderOne. Use our enrollment manuals to complete your enrollment in the ProviderOne application. Receive accurate payments for covered services. Recruitment. CPT® is a trademark of the American Medical Association. 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. Verify you are an eligible provider. Learn about changes to rates and updates to our billing guides. 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. States can use a managed care delivery system by getting a state plan amendment approved by CMS. Washington State Medicaid HIT plan. 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. Upon initiation or renewal of a contract with the Washington state health care authority to administer a Medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as if the health care service was provided in person by the provider. Health Technology Clinical Committee. Phones are closed on Mondays, Wednesdays, and Fridays. Topic selection. Health Technology Assessment. 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. Search. Topic . Respond to provider requests for more step-by-step reference materials for ProviderOne. Medical Nutrition Therapy fee schedule (2020-10-01) PDF. By 2019, our intent is that the advancement of purchasing towards fully. Search . You will use these regularly as you submit your claims. Stay informed! 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. Healthier Washington . Respond to provider requests Key questions. Document Type . WA EVV Implementation Guide for Home Care Agencies Dated: February 3, 2020 5 2. Paul Means, and his firm Abilia Healthcare, were targeted following an audit of its billing by the Washington State Health Care Authority that revealed irregularities, according to court records. Group practice Healthier Washington is a multi-sector partnership working to improve health, transform care … 2019). Coverage decision and meeting. Complete the supplemental paperwork for your provider type. 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. WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-90 (Sep. 2020). Washington’s EVV process for Home Care Agencies: To comply with Cures Act requirements, and to allow the State to conduct efficient quality … PDF download: Billing Guide – Washington State Health Care Authority. The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: Find client eligibility for services. Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. How we work. 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. What is Washington Apple Health (Medicaid)?. (Accessed Aug. 2019). 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. Washington State Health Care Authority Medicaid Provider Guide . Licensed health care groups and facilities (including suppliers and contractors of service). 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). Subject Change Provider Notice 12-111 January 1, 2013 Page 22 Limited Visual Oral Assessment Learn more about your customer service options. 1. Evidence report. Coverage decision and meeting. The following programs have individual MPGs: Wheelchairs & Durable Medical Equipment and Supplies Medicaid Provider Guide Medical Nutrition Medicaid Provider Guide (Accessed Sep. 2020). Get Provider billing guide . This guide only pertains to Medicaid coverage. 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. 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. Due to COVID-19, HCA’s lobby is closed. This publication supersedes all previous Agency Tribal Health Program Billing Instructions published by the Washington State Health Care Authority. Washington Apple Health (Medicaid) programs eligibility overview. How we work. You can also visit or … Washington State Medicaid Transformation Waiver … – Medicaid.gov. How to use this guide. Notice: If you are looking for Apple Health (Medicaid) client forms and publications, please visit our Free or low-cost forms library. Before you begin your application, select the provider type that matches your situation (see below). Technology selection. 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. EVV Implementation Plan 2.1. Tribal Health, Health care professional practicing under a group or facility. Receive accurate payments for covered services. Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. 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. A Billing Instruction . For best results, bookmark this page so that you are always using the most up-to-date version of the guide. Services and/or equipment related to any of the programs listed below must be billed using their What Has Changed? Phone: 1-800-562-3022, ext. They are presented here for your convenience. The positive outcomes achieved by a previous State Chronic Care Management Program led Washington to adopt a comparable model, organized on the principles of patient activation and engagement. Contact us. Key questions. A Billing Instruction . Reset filters. 4. Washington State Health Care Authority Medicaid Provider Guide . 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. Billing Guide – Washington State Health Care Authority. Due to COVID-19, HCA’s lobby is closed. Tracking success. Clinical experts. 6. Review our new provider next steps. To find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. Interested in becoming an Apple Health (Medicaid) provider or need to find out if you are enrolled? About this publication This publication supersedes all previous Department/MPA Chemical-Using Pregnant (CUP) Women Program Billing Instructions. Provider Guide – Washington State Health Care Authority. 3. Note: The Department now reissues the entire billing manual when making updates, rather than just a page … Tribal Health Program . Box 45531 Olympia, WA 98504. Washington State Health Care Authority. Bill in a timely fashion. 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. What we're working on . Box 45530 • Olympia, WA 98504-5530. WASHINGTON STATE MEDICAID CORE COMPANION GUIDE 3/2015 005010 Version 1.0 2 2015 WA State Medicaid Companion Guide Preface . 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. The effective date and revision history are now Where can I get help completing my application? Decision complete. 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. 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. 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