Health Care Authority Medicaid Provider Guide Chemical-Using Pregnant (CUP) Women Program -5330701 WAC 388 0730] A Billing Instruction . Health Technology Assessment. Tribal Health, Health care professional practicing under a group or facility. Aug 25, 2015 … Benefit Specifications and Provider Qualifications Form – Supportive ….. deployment of common statewide performance measures to guide health care …. Technology selection. Medical Nutrition Therapy [WAC 388-550-6300] July 1, 2011 . Box 45530 • Olympia, WA 98504-5530. 1. WASHINGTON STATE MEDICAID CORE COMPANION GUIDE 3/2015 005010 Version 1.0 2 2015 WA State Medicaid Companion Guide Preface . 2. Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. By 2019, our intent is that the advancement of purchasing towards fully. Washington Apple Health (Medicaid) programs eligibility overview. 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. October 2018. About this Guide . 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. Washington Healthplanfinder for MAGI Medicaid at (855) 923-4633 Monday through Friday 7:30 AM to 5:30 PM. Coverage decision and meeting. Medical Nutrition Therapy fee schedule (2020-10-01) Provider billing guide. Reset filters. A Billing Instruction . Phones are closed on Mondays, Wednesdays, and Fridays. 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. Receive accurate payments for covered services. Bill in a timely fashion. What we're working on . Fac/Agncy/Orgn/Inst 6. Review our new provider next steps. Before you begin your application, select the provider type that matches your situation (see below). 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). About this Publication . Washington State Medicaid HIT plan. Clinical experts. Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. Washington Medicaid Provider Manual. 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. 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. (Accessed Aug. 2019). WA EVV Implementation Guide for Home Care Agencies Dated: February 3, 2020 5 2. Subject Change Provider Notice 12-111 January 1, 2013 Page 22 Limited Visual Oral Assessment View the complete guide The guide is intended to: Strengthen the current instructions that apply to nearly all types of providers. WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-90 (Sep. 2020). Use this chart to match the provider types above with the enrollment type options in ProviderOne. Key questions. About this guide . (Accessed Sep. 2020). Topic . Contact us. How we work. Search. Apr 1, 2016 … Physician-Related Services/Health Care Professional Services. Medical Nutrition Therapy fee schedule (2020-10-01) PDF. Learn about changes to rates and updates to our billing guides. Reason for Change Effective Date Page No. Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 92 (Jul. Note: The Department now reissues the entire billing manual when making updates, rather than just a page … Washington State Medicaid HIT plan. Health Technology Clinical Committee. 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. Committee members. 3. Respond to provider requests for more step-by-step reference materials for ProviderOne. 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. They are presented here for your convenience. Sort by. 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. Interested? By 2019, nearly 600,000 new enrollees were receiving Apple Health for Adults coverage. How to use this guide. View MAC memo for rate changes effective February 1, 2021. Topic selection. 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 askmagi@hca.wa.gov; By mail at: P.O. School Based Services. 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. Decision complete. A Billing Instruction . instructions for adding Billing Type and Available Agencies in ProviderOne, Website feedback: Tell us how we’re doing. Interested in becoming an Apple Health (Medicaid) provider or need to find out if you are enrolled? 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: The appendixes below are included in the complete guide. Where can I get help completing my application? Services and/or equipment related to any of the programs listed below must be billed using their WASHINGTON STATE MEDICAID CORE COMPANION GUIDE … Provider Guide – Washington State Health Care Authority. Due to COVID-19, HCA’s lobby is closed. Due to COVID-19, HCA’s lobby is closed. Key questions. CPT® is a trademark of the American Medical Association. Tracking success. For best results, bookmark this page so that you are always using the most up-to-date version of the guide. Strengthen the current instructions that apply to nearly all types of providers. To find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. Download our instructions for adding Billing Type and Available Agencies in ProviderOne. Washington State Health Care Authority Medicaid Provider Guide . Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. Receive accurate payments for covered services. 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. Recruitment. Search . Billing Guide – Washington State Health Care Authority. Stay informed! What is Washington Apple Health (Medicaid)?. You will use these regularly as you submit your claims. Coverage decision and meeting. The following programs have individual MPGs: Wheelchairs & Durable Medical Equipment and Supplies Medicaid Provider Guide Medical Nutrition Medicaid Provider Guide Group practice The state plan preprint includes information such as the types of entities that will be used and what groups of people will be enrolled. Your contact information is used to deliver requested updates or to access your subscriber preferences. Clinical experts. 2. Technology selection. This publication supersedes all previous Agency Tribal Health Program Billing Instructions published by the Washington State Health Care Authority. 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. Tribal Health Program . Healthier Washington is a multi-sector partnership working to improve health, transform care … 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. Licensed health care groups and facilities (including suppliers and contractors of service). The Washington State Department of Health; The University of Washington School of Dentistry; The Washington Dental Service Foundation; The Washington State Dental Association; Local dental societies; Local health jurisdictions; and Other funding sources. Washington State Health Care Authority Medicaid Provider Guide . Health technology reviews . The effective date and revision history are now The following enrollment manuals provide step-by-step instructions for completing your application within ProviderOne. States can use a managed care delivery system by getting a state plan amendment approved by CMS. 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. Verify you are an eligible provider. About this publication This publication supersedes all previous Department/MPA Chemical-Using Pregnant (CUP) Women Program Billing Instructions. The Washington State Health Care Authority (HCA) manages the work of the demonstration under the banner of Governor Jay Inslee’s Healthier Washington initiative. 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. Follow our guidelines to prepare for the enrollment process. Health Technology Assessment. 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.). This guide supersedes all previous Agency Dental Medicaid Provider Guides and is published by the Medicaid Program of the Washington State Health Care Authority. Health Technology Clinical Committee. 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). About This Publication . Respond to provider requests Learn more about your customer service options. You can also visit or … This guide only pertains to Medicaid coverage. 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. Complete the supplemental paperwork for your provider type. What we're working on. Washington’s EVV process for Home Care Agencies: To comply with Cures Act requirements, and to allow the State to conduct efficient quality … Use our enrollment manuals to complete your enrollment in the ProviderOne application. Topic selection. Healthier Washington . A Billing Instruction . 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. 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). How we work. Evidence report. 4. 2019). Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. Box 45531 Olympia, WA 98504. 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. 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. Nursing Facilities [Chapter 388-96 WAC] May 15, 2013 . Phone: 1-800-562-3022, ext. 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. 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Washington State Medicaid CORE COMPANION Guide Preface washington state health care authority medicaid provider guide Tell us how We ’ re doing EVV Implementation Guide Home! The Guide is intended to: Strengthen the current instructions that apply to nearly all types providers!