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Medicaid Providers Home

Apple Health Managed Care Changes

In April 2016, changes will begin for individuals applying for or renewing Apple Health (Medicaid) coverage and enrolling into a managed care plan. These changes include:
  • Earlier Enrollment
  • Behavioral Health Organizations 
  • Fully Integrated Managed Care (in SW WA)
  • Apple Health Foster Care

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All Apple Health (Medicaid) providers - notice of important change to paper billing!

Effective October 2016, the Health Care Authority (HCA) will accept only electronic claims for Apple Health (Medicaid) services, except under very limited circumstances. We are making this change to improve efficiency in processing claims.

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. Examples of these unusual circumstances may include but are not limited to:

  • HCA notifies provider in writing that paper claims will be accepted due to ProviderOne system issues precluding acceptance of electronic claims.
  • The provider can demonstrate that the information needed for adjudication of an Apple Health (Medicaid) claim cannot be submitted electronically using the claim formats required under the ProviderOne Billing and Resource Guide.
  • The provider is experiencing a disruption in their electricity or communication connection that is outside of his or her control and is expected to last longer than two days. This exception applies only while electricity or electronic communication is disrupted.
  • Providers that have not submitted any electronic claims within the past state fiscal year (July 1, 2015 to June 30, 2016).

Providers who wish to ask for an exemption from submitting claims electronically may do so using the Request a Waiver form. Look for this form to arrive with a second notice in August.

If you need further information regarding this notice, please contact the HCA Customer Service Center at 1-800-562-3022. 

New! Important Apple Health Managed Care Changes

To view full details on Earlier Enrollment, Behavioral Health Organizations, Fully Integrated Managed Care (in SW WA), and Apple Health Foster Care, please visit Apple Health Managed Care Changes - April 2016.

ProviderOne Routine Maintenance

ProviderOne maintenance occurs every eight weeks and requires that the system be unavailable (or down) for a period of time. During this downtime, the vendor promotes the correction of system bugs and/or system enhancements.

When does maintenance occur? 

  • Every 8 weeks
    • January—June, Sunday from 5 a.m. to 3 p.m. Pacific Time 
    • July—December, Friday from 6 to 10 p.m. Pacific Time

What transactions will be affected?

  • Eligibility inquiries via the website WILL NOT be available during maintenance hours
  • Eligibility inquiries through the following systems WILL NOT be available during maintenance hours:
    • The automated telephone system (IVR) 1-800-562-3022
    • A Medicaid Eligibility Vendor

    • A Services Card swipe card reader

All other direct entry transactions in the website will not be available until after 10 p.m.

HIPAA batch transactions  

HIPAA batch file transactions submission and retrieval using secure FTP will not be affected by these maintenance activities, but any new batch transactions submitted will not be processed until the system is back up, after 10 p.m.

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