Enroll as a billing provider
Instructions on how to enroll as a billing provider for Washington Apple Health (Medicaid).
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Yes. An application fee may be required to complete your enrollment in compliance with federal regulations under 42 CFR 455.460.
Effective June 1, 2016, Washington Apple Health (Medicaid) is implementing an application fee for institutional provider enrollment applications. Providers who are enrolled with Medicare and providers currently enrolled with Apple Health will not be affected. Providers who will be subject to the application fee will be notified by HCA when the fee is required.
The application fee for 2017 is $560.
You will need to submit a number of documents with your application. Listed below are required and optional documents. You may also need to complete provider-specific documents based on your provider type.
All forms requiring a signature must be signed by an individual with legal authority to bind provider. Signatures are required on: Core Provider Agreement, Debarment Statement, Electronic Funds Transfer and W-9 for the form to be considered complete.
Documentation sent to Provider Enrollment requires a document submission cover sheet. You will be prompted to complete and print the cover sheet once you have submitted your online application.
- Core Provider Agreement in PDF and Word
- Debarment Statement in PDF and Word
- Copy of Internal Revenue Services (IRS) Form W-9
- Copy of liability insurance
- Practice-specific supporting documents
Do not send the following
- Curriculum vitae or resumes
- Copies of driver's licenses or passports
- Double-sided documentation
You must send all required documentation noted above with signatures, if required. At the end of the application process, you will be given instructions for sending the necessary documents.
Once you have completed step one of the application you will be given a 16-digit application ID number. Write this number down in case you need to save and access your application at a later time. The online application has up to 18 steps. If you do not have time to complete it now you will need your application number to regain access.
Important! This is not the end of the online application. There are 16 additional steps. Click OK in the bottom right corner of the screen once you receive your application ID number to continue and complete your application. If you do not complete the application it will be dropped from the system with no record.
What enrollment type option should I select?
- Individual: If you are enrolling as an individual provider who owns your own practice. Note: If you choose to use your Social Security Number (SSN) as your tax ID you will need to update the servicing type to “Regular Individual Provider”.
- Group practice: If you are enrolling as an organization of individual providers who offer services.
- Fac/agncy/orgn/inst: If you are enrolling as a facility agency, organization or institution.
- Tribal health services: If you are enrolling as a tribal health provider.
If you started an online enrollment but have not completed the required steps, you may track your enrollment application* by using your 16-digit application ID and the Social Security Number (SSN) or Federal Employer Identification Number (FEIN) you entered in step one of your application. This allows you to complete the enrollment and submit it for review and approval.
*Link does not work for Health Care Authority staff.
- Enter your 16-digit application ID number then print the document submission cover sheet and attach it as the first page to all required documentation.
- Fax your documentation to the number on the document submission cover sheet.
- All forms and documentation must be received to complete the review and verification of your application.
What should I expect after I submit my application?
- Your application will be processed in the order it was received.
- Applications submitted online: expect up to 30 days to process.
- Applications submitted hard copy: expect up to 90 days to process.
- An application may take longer to process if it is:
- Requires program approval.
- Is missing required information or documents. You will be contacted if additional information is required.
- If your enrollment is approved you will be mailed a welcome letter.
Phone: 1-800-562-3022, ext. 16137
Phones are open: Mondays, Tuesdays, Thursdays, and Fridays 7:30 a.m. to 4:20 p.m. (Provider Enrollment phones are down on Wednesdays and also from 12:00 p.m. to 1:00 p.m.)