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

You may also want to visit:

 

ProviderOne payment change

For the week of June 27, 2016, due to the State fiscal year end for 2016, payments to providers will be made on Wednesday, June 29 which includes the delivery of the Remittance Advices (RAs) and HIPAA 835 payment files. Claims submitted to ProviderOne after 5 p.m. Sunday, June 26 through 6 p.m., Tuesday, July 5 will be included in the payment made on Friday, July 8, 2016.

New Washington Apple Health Customer Service Center hours of operation

The Medical Assistance Customer Service Center (MACSC) toll free line 800-562-3022 is now available earlier starting at 7 a.m. to support providers Monday through Friday. Closing times for the different phone lines will remain the same:

  • Client lines: 7 a.m. – 5 p.m.

  • Provider lines: 7 a.m. - 4:30 p.m.

  • Claim line: 7 a.m. – noon 

Hours of operation for the authorization lines remain unchanged.
 
Many provider questions can be answered quickly any time of day through interactive telephone features or within the HCA website. To contact the customer service center or the ProviderOne Help Desk by e-mail, complete our secure web form. Additional help on provider topics is also available in the ProviderOne Billing and Resource Guide.

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.

Detailed Calendar

First-Timers' Guide to Washington Apple Health (Medicaid)

The Health Care Authority has developed a First-Timer's Guide to Washington Apple Health (Medicaid) which providers may find useful in understanding some of the common questions and concerns our clients have. Versions in other languages can be found at our publications website under publication 19-024.