ProviderOne Billing and Resource Guide

A complete guide for using ProviderOne.

Important! On January 1, 2017, the Health Care Authority (HCA) changed the process for managing Apple Health (Medicaid) benefits for clients with other primary health insurance. Learn about these changes.

The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff:

  • Find client eligibility for services.
  • Bill in a timely fashion.
  • Receive accurate payments for covered services.

The guide is intended to:

  • Strengthen the current instructions that apply to nearly all types of providers.
  • Respond to provider requests for more step-by-step reference materials for ProviderOne.

Paperless billing has arrived!

As of October 1, 2016, all Apple Health (Medicaid) providers (excluding Tribal billing offices) are required to submit electronic claims for Apple Health (Medicaid) services.

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. If you feel you may qualify, review the Request a Waiver from Electronic Billing form for the criteria. 

Please review the Elimination of Paper Claims frequently asked questions (FAQ) for more information. For questions not answered in the FAQ, please contact the HCA Customer Service Center at 1-800-562-3022.

For paper claim-approved providers ONLY: Paper Claim Billing Resource for questions about paper claim submission.

    Guide updated to reflect paperless billing

    As of October 1, 2016, the ProviderOne Billing and Resource Guide no longer contains references to paper claim billing. It is now focused solely on electronic claim submission.

    ProviderOne Billing and Resource Guide (complete guide)


    The appendixes below are included in the complete guide. They are presented here for your convenience.

    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 E - Benefit services packages

    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 I - Taxonomy and ProviderOne 

    Appendix J - Medicare crossover claim payment methodology

    Appendix K - Checking claim status with IVR 

    Appendix L - Checking warrants with IVR

    Please note: Appendix I, J, and K have been renamed to new topics and the previous material on paper claims has been moved to the new Paper Claim Billing Resource. See Paperless billing has arrived! for more details.

    Provider billing guides and fee schedules

    Use the provider billing guides and rates and fee schedules as companions to the billing and resource guide. You will use these regularly as you submit your claims.

    Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. For best results, bookmark this page so that you are always using the most up-to-date version of the guide.


    Medical Assistance Customer Service Center (MACSC)
    Online: Web form
    Phone: 1-800-562-3022