Receiving the right health care is about: Having regular checkups to stay healthy; Seeking help when you are sick; Being able to visit a provider you can trust with Washington State WebManaged care is a prepaid, comprehensive system of medical and health care delivery. In cases where copayments are due, Medicaid coverage caps the amount a provider may charge for services. Were asking Apple Health clients to be aware of suspicious contact seeking money to maintain their health coverage. HCA will automatically enroll clients into a BHSO plan if they do not select one. WebMedical providers Kaiser Permanente NW Kaiser Foundation Health Plan of the NorthWest offers plans in Clark and Cowlitz counties in Washington and select counties in Oregon. As a covered entity wishing to submit electronically, you must: See a list of approved clearinghouses, billing agents, and software vendors. For example, children receive extra aid for services such as: The answer to, What does Medicaid not cover in Washington? means understanding the limitations of the program. Were here to make your job easier. Appeals and Disputes Use Advanced Search and search by Member Name, Member ID or Case ID, Use Advanced Search to search documents for any 90-day period up to 2 years. Denied coverage? To learn more about ComagineHealth, view "Medical Necessity Review by ComagineHealth" in the Physician-related/health care professional services billing guide. CHPW has programs in place for members who want help managing their conditions or who need community services. Provider The Apple Health Foster Care (AHFC) program provides statewide physical and behavioral health coverage (mental health and substance use disorder treatment services). When you visit a BH-ASO, they can help you navigate through mental health or substance use disorder (SUD) services when needed. Under the age of 21 who are in foster care (out of home placement), Under the age of 21 who are receiving adoption support, Age 18 to 26 years old who aged out of foster care on or after their 18th birthday (alumni). Therapies, such as physical and speech aids. This is not a complete description of benefit. The types of services that help an adult remain at Copyright 2020. WebPrograms: I-N Programs: O-P Programs: Q-Z Become an Apple Health provider About HCA Programs & initiatives Who we are Data & reports Stay up-to-date with rate, billing, and ProviderOne system changes. Testing and treatment for specific diseases. Washington Apple Health (Medicaid) clients who receive the following coverage: Medical - Apple Health Provider WAC 2 Kaiser Foundation Health Plan of Include Request for Participation in Behavioral and Medical Contracting in the subject line. Phone:988 (1-800-273-8255)Online:988 Suicide & Crisis Lifeline, Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, Apple Health public health emergency (PHE), Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. The Partnership Access Line (PAL) is a mental health consultation resource available to all primary care providers to help practices deliver more effective mental health care for any child they see, regardless of insurance. Login Problems? The state-specific requirements and process on how to join the UnitedHealthcare Community Plan networkis found in the UnitedHealthcare Community Plan Care Provider Manuals. CHPW is committed to Washington's health. We are a team of experts dedicated to finding the right government programs for you. Nonmedical social service providers: Receive a 1099 tax form from the state of Washington. However, Medicaid coverage does not always mean that there is no cost associated with the assistance. Send us a secure message through HCA Support. Washington State Washington has received reports of fake texts and phone calls to Apple Health (Medicaid) clients about renewing their Apple Health coverage. Cost and Coverage of Medicaid in Washington There are a variety of programs that provide free or low-cost medical services to people who are eligible. Step 2: Determine if a code or service requires prior authorization, Step 5: Check the status of an authorization. For a complete list, visit our Provider billing guides and fee schedules webpage. WebWASHINGTON STATE PROVIDER FAQ & CONTACT LIST Apple Health-IMC MolinaHealthcare.com . Help us resolve your concerns more quickly by providing the following details: Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, ProviderOne Trading Partner Agreement (TPA), approved clearinghouses, billing agents, and software vendors, 276/277 Claim status request and response, 820 Payroll deducted and other premium payment, Payer initiated eligibility (PIE) transaction, Centers for Medicare and Medicaid Services, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. It is offered to low-income Washington residents so that they are able to get the health services that they need at a low cost or even free. Vision benefit information. The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to: Enhance policies related to program integrity With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories. The documentation required when submitting. Use FastAttachTMservices provided by Vyne Dental (formerly NEA). In some cases, Medicaid coverage will not help a potential beneficiary. UnitedHealthcare Community Plan of Washington This change includes letters sent by Optum for payment accuracy reviews they perform on behalf of UnitedHealthcare. You should be able to find the provider's office contact information through your health plan's website. A Decrease font size. Providers must be certified in the SBIRT model to implement this approach and offer SBIRT services. Server Time: 08/19/2023 03:18:13 PDT. Open the appropriate billing guide and/or fee schedule based on the date of service to search for the code or service. Participating Providers are required to interact with Molinas HCS Department electronically whenever possible. Provide services to clients who are eligible for Medicaid services. Submit x-rays or photos (if required) It may be time to complete your renewal. Note: this is for provider groups and facilities who have both medical and behavioral health providers only. Denied coverage? Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, First Steps (maternity support & infant care), Home health care services: electronic visit verification, Intensive behavioral health treatment facilities, Preadmission screening and resident review, Resources for behavioral health providers, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19), View our announcement for more information, Apple Health managed care plans available, Apple Health services covered without a managed care plan, Apple Health (managed care) service area matrix, Apple Health (managed care) service area map, value-added benefits offered through your managed care plan, Welcome to Washington Apple Health client booklets. Upon successful submission, a provider will receive a 9-digit reference number; the reference number is verification that the agency has received your request. As an Apple Health client, you have a right to receive accessible services from your health care provider. It may be time to complete your renewal. How do I notify PEBB that my loved one has passed away? Note: The General Information for Authorization form (13-835) must be typed and be page 1 of your fax to avoid delays. Strengthening families so children have the care and support they need to reach their full potential. Provider Center - Washington State Local Health Insurance - CHPW All Your CHPW Provider Tools Submit forms, check on patient eligibility, and more through your The Health Care Authority may be Washington Medicaid digital updates | UHCprovider.com First, call whoever is billing you to find out why they are billing you. You may have heard of Washington Medicaid by its other name Apple Health. Screening, brief intervention, and referral to treatment (SBIRT), Tools and resources for substance use professionals, HealtheKnowledge seven-moduleSBIRT course. How do I request prior authorization (PA) for services? If you are interested, please let us know. A written request for prior authorization is required when a situation does not meet all the EPA criteria. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, First Steps (maternity support & infant care), Home health care services: electronic visit verification, Intensive behavioral health treatment facilities, Preadmission screening and resident review, Resources for behavioral health providers, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19). No one program will be the best option for everyone. Medicaid coverage benefits are either mandatory and required by all states to implement, or are optional. WebProgram benefit packages and scope of services. Denied coverage? Webto your login for Washington state. WebTo find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. Use the following resources to learn how to use ProviderOne to submit a claim: All claims for eligible services are submitted and paid through ProviderOne. See how CHPW ensures appropriateness, medical need, and efficiency of health care services received by our members. Note: The General Information for Authorization form (13-835) must be typed and be page 1 of your fax to avoid delays. Want to learn about who we are? WebProvider Credential Search. You will also need to list all of the birthdays and SSNs for each member of the household. Are you enrolled in Apple Health (Medicaid) coverage? Printable map; Directions; Washington State Medicaid Explorer; Opioid use disorder treatment; Behavioral health housing program map; Healthier Washington measures; Braces for teeth when needed for health reasons. The ABA provider will then complete their own evaluation of the client and develop an ABA treatment plan. The cooperation between officials and essential funding helps create a system which allows each state to adjust accordingly and provide assistance in the best interest of eligible petitioners. After your report is made, we will work to detect, correct and prevent fraud, waste, and abuse in the health care system. Here you will find billing guides and fee schedules for that program or service. Legal guardians, caretakers, and parents have to reside with children under 18 while also meeting the income requirements, Disabled, blind, or aged applicants have to meet both medical and income requirements, Proof of the full legal name for each household member, Social Security Number for each household member, Annual income as evidenced by documents providing proof of income, Legal presence papers or citizenship documentation, If you currently have health insurance, you will need information regarding it, All of these things for each member of the household. Washington has received reports of fake texts and phone calls to Apple Health (Medicaid) clients about renewing their Apple Health coverage. The following materials are available from Products | X12to assist you in your submissions: If you have questions related to your HIPAA EDI files or responses, please submit a ticket at hipaa-help@hca.wa.gov. Drug and alcohol treatment services are covered by: To learn more about becoming a provider, visit ourBecome a behavioral health providerpage. WebOlympia, WA 98504-5561. Officials alert approved petitioners and offer detailed information, such as the maximum potential costs. WebHCA Find-a-Provider Who should use the Find a Provider search tool? Learn about requirements forjoining our network. Important: Stay covered! Billing providers submit all claims through ProviderOne. There are three main parts Most of the time, all of the services will be included, but some services will be paid through what is known as a fee for service. Apple Health coverage without a managed care plan is sometimes necessary due to the way other coverage works with Apple Health for instance, when clients have Medicare as their primary coverage. Fax: 360-457-3820. Providers must not bill or perform a procedure(s) until the agency has provided written approval. Welcome to MMIS Other services that might be covered, depending on the plan you choose, are treatment for chemical and alcohol dependency, interpreters for appointments for people who dont speak English, doctor appointments, newborn and maternity care, and mental health services. Our goals are to prevent substance use disorders and support holistic, evidence-based, person-centered care that addresses both medical and behavioral health conditions. Following certain criteria, the agency allows for use of an EPA. provider How do I notify PEBB that my loved one has passed away? Denied coverage? Copyright To access other health plans, visit OneHealthPort. WebThe 340B Drug Pricing Program is a federal program created in 1992 for section 340B (a) (4) of the Public Health Service Act (PHSA). The Health Care Authority can only reimburse agencies that are licensed and certified to provide Applied Behavioral Analysis (ABA )services through the Department of Social and Health Services Division of Behavioral Health and Recovery (DSHS/DBHR) Those letters will continue to be mailed. You may still be eligible. Check out Care Conductor in the UnitedHealthcare Provider Portal under Clinical & Pharmacy. 24/7 regional crisis hotline for mental health and substance use disorder (SUD) crises. Program standards for income and resources - Information regarding current and past income standards for both MAGI and non-MAGI programs, including resource standards. Some of these services include: The BH-ASO can choose when to provide outpatient behavioral health services or voluntary psychiatric inpatient hospitalizations for individuals who are not Apple Health clients. WebFirst Step Family Support Center. Effective June 2, 2023, we will no longer print and mail appeal decision and overpayment letters for most1 UnitedHealthcare Community Plan (Medicaid) health plans. Helpful Web Addresses. Prior authorization fax line: 1-866-668-1214, Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. Have a contract with DSHS. Phone: 360-457-8355. WebIntroduction overview - This section describes the eligibility requirements for the various medical programs and coverage administered by the department. Some of the types of Medicaid services that are mandatory to cover include: To review the list of Medicaid services, download our free guide. 30409LTRMDWAEN_2023 WA Medicaid Provider FAQ & Contact List - For 508c.indd 1 24/01/23 11:06 PM contact matrix (855) 322-4082 This document is intended to provide you, our valued provider, with contact information to assist you in Please enter your organization name, practice location street address, city, state or province and ZIP code+4. Next you will enter your National Provider Identifier (NPI) number, federal tax ID or WebHow to Apply for Medicaid. Welcome to MMIS Some services are paid for by Apple Health without a managed care plan, also called fee-for-service (FFS). It provides intensive mental health services to support you and your family in meeting your goals. Washington State ProviderOne | OneHealthPort Most Apple Health clients have managed care. Your plan coordinates physical health, mental health, and substance use disorder treatment services to provide whole-person care under one health plan. The level of medical coverage for any given client depends on the medical program for which the client is eligible. Call CHPW See Your Options. Email the form to us at WAcollaborativecare@uhc.com. To get started, go to API Marketplace and sign in to the marketplace with your One Healthcare ID and password. The best way for primary care providers (PCPs) to view and export thefull member roster is using the CommunityCare tool, which allows you to: For help using CommunityCare, please see ourQuick Reference Guide. Our team is dedicated to researching and providing you with the most relevant information. When you report a situation that could be considered fraud, youre doing your part to help save money for the health care system and prevent personal loss for others. If you are a hospital, facility, group or individual that practices only behavioral health or only medical health, please refer to the instructions found under Get Started here. The EPA number must be used when the provider bills the agency. People who are interested in finding out how to qualify for Medicaid will come to find that there are both financial and personal requirements. Provider groups and facilities in Washington who employ both medical and behavioral health providers and wish to contract for Medicaid should contact Washington Network Management at Networkhelp@uhc.com. If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, First Steps (maternity support & infant care), Home health care services: electronic visit verification, Intensive behavioral health treatment facilities, Preadmission screening and resident review, Resources for behavioral health providers, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19). Your managed care enrollment is backdated to the beginning of the current month. Receive payment through use of a social services authorization. Our Provider FAQs have detailed Managed care plans should notify providers, both prescribers and pharmacies, of this change and begin accepting Synagis requests. provider 182-502-0002 The majority of people will have to choose an MCO (Managed Care Organization). Each managed care plan also provides Value-Added Benefits for their members. You can retake trainings anytime. Access to high volumes of Provider Credential Search data is available at our open data portal. The Health Care Authority (HCA) in Washington administers Medicaid coverage and oversees the federally established guidelines for the program, along with all the services included. To view a list of qualifying services, download our EPA inventory. Only users are able to submit claims in ProviderOne. Cherry Street Plaza 626 8th Avenue SE Olympia, WA 98501. Some services require prior authorization (PA) before you can provide the service. They will also have a premium that is on a sliding scale and will never be more than 7.5%. For example: Check the physician fee schedule and the ambulatory surgery center (ASC) fee schedule if you are performing the service in an ASC to: The following is a shortened list of regularly used billing guides and fee schedules. Youare required to successfully complete EDI testing for each HIPAA transaction you plan to use. How do I notify SEBB that my loved one has passed away? Criteria are explained in each of the program provider guides. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, First Steps (maternity support & infant care), Home health care services: electronic visit verification, Intensive behavioral health treatment facilities, Preadmission screening and resident review, Resources for behavioral health providers, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19). WebThe provider dashboard contains various sets of interactive provider data and displays active current counts of specific provider categories and types. Web1099 social services-only provider. Medicaid | DSHS - Washington State Department of Denied coverage? WebHealth Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) is an electronic method of communicating standard transactions between covered entities (providers, clearinghouses, and health plans).

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