(Use for claims billed on and after July 1, 2014.)
The effective date and Change Log related to the current guide now appear in a table on page 2 of the manual titled "What has Changed?
Note: Please do not print this document. The Health Care Authority may make occasional changes to reflect current policy, program updates, and ProviderOne system enhancements.
If you print the document and use the paper copy instead of the webpage, your version may become outdated.
Please use this webpage and check it frequently.
View and download the following HCA forms which are discussed in this Guide:
- Authorization Agreement for Electronic Funds Transfer, form HCA 12-002
- Electronic Funds Transfer (EFT) Authorization Change, form HCA 12-003
Third Party Insurance Carrier Codes
Document Submission Cover Sheets