Coming soon! The Health Care Authority launches its new, user-focused website on August 1.

New Providers

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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Medicaid is a Federal and State funded health care program that provides health care coverage to eligible low-income residents of Washington State. The program is actively seeking new providers who can improve our clients' access to medical care around the state. Among public and private commercial payers, the Medicaid Program is one of the fastest in delivering services and payment to providers who submit clean claims.

Does Medicaid cover my type of services?

See the complete list of providers and services that are covered by Medicaid. More enrollment information can be found at the Provider Enrollment web site.

Can I limit the number of Medicaid patients?

Yes! The Agency does not require your practice to see every Medicaid client that may visit or call your office. You have the ability to set the number of patients you can see and efficiently operate your office. The Agency appreciates your enrollment as a Medicaid Provider and providing health care to eligible low-income residents of Washington State.

Online Enrollment

The Agency now requires online enrollment through the Provider Enrollment web site for new providers. The Agency recommends reviewing the appropriate New Provider Enrollment Manual listed on the Provider Enrollment web site before attempting to use the online enrollment forms. Have these general supporting documents (all that are applicable) on hand before starting the online enrollment process:

  • State Business License (if your state doesn't require a business license include a memo stating that it is not required)
  • IRS Form W-9
  • Current Professional License
  • Medicare certification letter
  • NPI
  • Practice-specific supporting documents for:
    • Ambulatory Surgery Centers
    • Dentists
    • Home Health Agency
    • Hospice
    • Hospitals & Lab Facilities
    • Psychiatrists
    • Registered Nurse First Assist (RNFA - Surgical Assists)

    Please go to the Provider Enrollment web site for complete enrollment information.

    Core Provider Agreement (CPA)

    Even though you have completed the online New Provider Enrollment Forms, the Agency requires the Core Provider Agreement, Ownership and Disclosure Form, and the Debarment Form with original signatures be mailed to the Provider Enrollment office. Copies of licensure and other qualifying documents are required to be sent with your application. See the list at our Provider Enrollment web site. See the list of specific cover sheets to attach to documents sent to the Agency including one for your CPA.

    How do I get my federal National Provider Identifier (NPI) number?

    National Plan and Provider Enumeration System (NPPES)

    Electronic Funds Transfer Agreement

    The Agency is now requiring all newly enrolled providers to receive their payment by direct deposit. Part of the new enrollment process would be to fill out the Electronic Funds Transfer (EFT) form and submit this form to the Agency with your new provider enrollment packet. The Agency makes payments on a weekly cycle and automatically deposits payment in your bank account by each Monday. See the list of specific cover sheets to attach to documents sent to the Agency including one for your CPA.

    What is a Taxonomy Code?

    Taxonomy codes are 10-character Federally established alpha numeric codes which health care professionals use to identify their unique specialty areas. They are a combination of Provider Type and Provider Specialty that are self-declared by health care providers during the National Provider Identifier enumeration process. The Health Care Provider Taxonomy code set is developed by the Centers for Medicare and Medicaid Services and is published twice a year in July and January.

    Health Care Provider Taxonomy Code Set