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. Then use the ProviderOne billing and claims system to complete your enrollment application. 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. Health Technology Clinical Committee. 4. Washington Medicaid Provider Manual. Washington Healthplanfinder for MAGI Medicaid at (855) 923-4633 Monday through Friday 7:30 AM to 5:30 PM. Individual Billing Guide – Washington State Health Care Authority. 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. Coverage decision and meeting. Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 92 (Jul. Which enrollment type should I select in the ProviderOne application? Phone: 1-800-562-3022, ext. Tribal Health, Health care professional practicing under a group or facility. Due to COVID-19, HCA’s lobby is closed. The following enrollment manuals provide step-by-step instructions for completing your application within ProviderOne. Washington State Health Care Authority Medicaid Provider Guide . Subject Change Provider Notice 12-111 January 1, 2013 Page 22 Limited Visual Oral Assessment The effective date and revision history are now WASHINGTON STATE MEDICAID CORE COMPANION GUIDE … The Washington State Health Care Authority (HCA) manages the work of the demonstration under the banner of Governor Jay Inslee’s Healthier Washington initiative. 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. Due to COVID-19, HCA’s lobby is closed. Washington State Medicaid HIT plan. How we work. This guide only pertains to Medicaid coverage. Clinical experts. Decision complete. About this Publication . The following programs have individual MPGs: Wheelchairs & Durable Medical Equipment and Supplies Medicaid Provider Guide Medical Nutrition Medicaid Provider Guide Evidence report. School Based Services. 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). 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). Washington’s EVV process for Home Care Agencies: To comply with Cures Act requirements, and to allow the State to conduct efficient quality … Recruitment. Verify you are an eligible provider. PDF download: Billing Guide – Washington State Health Care Authority. Health Care Authority Medicaid Provider Guide Chemical-Using Pregnant (CUP) Women Program -5330701 WAC 388 0730] A Billing Instruction . 3. This guide supersedes all Prosthetic & Orthotic Devices Medicaid Provider Guides (MPGs) published by the Medicaid Program of the Health Care Authority (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. 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. Healthier Washington . Respond to provider requests for more step-by-step reference materials for ProviderOne. Contact us. Services and/or equipment related to any of the programs listed below must be billed using their Health Technology Assessment. Interested? Washington State Health Care Authority. Committee members. You will use these regularly as you submit your claims. Topic selection. Learn more about your customer service options. The group or facility must be enrolled with HCA, and have a Core Provider Agreement with the agency. Topic selection. 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. Phones are closed on Mondays, Wednesdays, and Fridays. Tracking success. 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.). They are presented here for your convenience. Determine your provider type for enrollment (below). Respond to provider requests Medical Nutrition Therapy [WAC 388-550-6300] July 1, 2011 . About this publication This publication supersedes all previous Department/MPA Chemical-Using Pregnant (CUP) Women Program Billing Instructions. Learn about changes to rates and updates to our billing guides. Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. 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 . To download and print Agency Medicaid provider guides and notices, go to the Agency website at http://hrsa.dshs.wa.gov (click the Medicaid Provider Guides and Provider Notices link). Your contact information is used to deliver requested updates or to access your subscriber preferences. Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. Medical Nutrition Therapy fee schedule (2020-10-01) PDF. Use our enrollment manuals to complete your enrollment in the ProviderOne application. Fac/Agncy/Orgn/Inst Note: The Department now reissues the entire billing manual when making updates, rather than just a page … How we work. WA EVV Implementation Guide for Home Care Agencies Dated: February 3, 2020 5 2. Receive accurate payments for covered services. (Accessed Aug. 2019). 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. Box 45531 Olympia, WA 98504. Search. Interested in becoming an Apple Health (Medicaid) provider or need to find out if you are enrolled? Washington State Health Care Authority Medicaid Provider Guide . 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. CPT® is a trademark of the American Medical Association. 1. About this guide . Health technology reviews . 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. 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. Decision complete. Licensed health care groups and facilities (including suppliers and contractors of service). Health Care Authority Medicaid Provider Guide . (Accessed Sep. 2020). Reset filters. Provider Guide – Washington State Health Care Authority. 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. You can also visit or … EVV Implementation Plan 2.1. How to use this guide. Complete the supplemental paperwork for your provider type. Coverage decision and meeting. 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. Healthier Washington is a multi-sector partnership working to improve health, transform care … Document Type . For best results, bookmark this page so that you are always using the most up-to-date version of the guide. P.O. Key questions. 5. To find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. Aug 25, 2015 … Benefit Specifications and Provider Qualifications Form – Supportive ….. deployment of common statewide performance measures to guide health care …. Contact us. 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). A Billing Instruction . The state plan preprint includes information such as the types of entities that will be used and what groups of people will be enrolled. States can use a managed care delivery system by getting a state plan amendment approved by CMS. What is Washington Apple Health (Medicaid)?. About This Publication . Before you begin your application, select the provider type that matches your situation (see below). Key questions. 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. 2019). Tribal Health Program . Strengthen the current instructions that apply to nearly all types of providers. Follow our guidelines to prepare for the enrollment process. 6. Review our new provider next steps. October 2018. This publication supersedes all previous Agency Tribal Health Program Billing Instructions published by the Washington State Health Care Authority. Where can I get help completing my application? Search . Washington State Medicaid Transformation Waiver … – Medicaid.gov. 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. 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. About this Guide . Receive accurate payments for covered services. WASHINGTON STATE MEDICAID CORE COMPANION GUIDE 3/2015 005010 Version 1.0 2 2015 WA State Medicaid Companion Guide Preface . Download our instructions for adding Billing Type and Available Agencies in ProviderOne. 2. Nursing Facilities [Chapter 388-96 WAC] May 15, 2013 . Technology selection. 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 . 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. 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. Learn more about your customer service options. Use our enrollment manuals to complete your enrollment in the ProviderOne application. Medical Nutrition Therapy fee schedule (2020-10-01) Provider billing guide. Reason for Change Effective Date Page No. Box 45530 • Olympia, WA 98504-5530. What we're working on . View MAC memo for rate changes effective February 1, 2021. A Billing Instruction . 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. 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