Enroll as a non-billing individual provider
Enrollment process for individual health care professionals enrolling for the sole purpose of ordering, referring and prescribing services.
On this page
The Nonbilling Individual Provider Agreement is for individual health care professionals who wish to enroll for the sole purpose of ordering, referring and prescribing services for Washington Medicaid clients. Do not enroll as a non-billing provider if you intend to submit claims for reimbursement from Apple Health (Medicaid).
Important! Any existing Core Provider Agreement and/or any enrollment under a group of providers will be terminated and replaced by the Non-billing Individual Provider Agreement. If your intent is to be listed on claims you should not use this application.
For additional information, refer to the Non-billing Individual Provider Agreement ( See WAC 182-502-0006).
The Nonbilling Individual Provider Agreement is a four-page paper application.
Fax the following documents to the Health Care Authority, Provider Enrollment, 360-725-2144:
For questions or assistance with your application please contact Provider Enrollment at 1-800-562-3022, ext. 16137 or submit a help request.
Phone: 1-800-562-3022 Ext 16137