Enroll as a non-billing individual provider

Enrollment process for individual health care professionals enrolling for the sole purpose of ordering, referring and prescribing services.

Who should enroll as a non-billing provider?

The Nonbilling Individual Provider Agreement is for individual health care professionals who wish to enroll for the sole purpose of ordering, referring and prescribing services for Washington Medicaid clients. Do not enroll as a non-billing provider if you intend to submit claims for reimbursement from Apple Health (Medicaid).

Important! Any existing Core Provider Agreement and/or any enrollment under a group of providers will be terminated and replaced by the Non-billing Individual Provider Agreement. If your intent is to be listed on claims you should not use this application.

For additional information, refer to the Non-billing Individual Provider Agreement ( See WAC 182-502-0006).

How long is the application?

The Nonbilling Individual Provider Agreement is a four-page paper application.

How do I complete enrollment?

Fax the following documents to the Health Care Authority, Provider Enrollment, 360-725-2144:

  • Nonbilling Individual Provider Agreement in PDF or Word
  • Copy of liability insurance

Who do I contact for assistance?

For questions or assistance with your application please contact Provider Enrollment at 1-800-562-3022, ext. 16137 or submit a help request.

Contact

Provider Enrollment
Phone: 1-800-562-3022 Ext 16137