Enroll as a nonbilling provider

Enrollment process for providers that are providing services to Apple Health (Medicaid) clients under a Managed Care Entity or Behavioral Health Organization (not under the fee-for-service Apple Health program) -or- if enrolling for the sole purpose of becoming an ordering, referring, prescribing provider.

Compile your application materials then proceed to ProviderOne.

Complete your enrollment

Who should enroll as a nonbilling provider?

Providers who are providing services to Apple Health (Medicaid) clients under a Managed Care Entity or Behavioral Health Organization (not under the fee-for-service Apple Health program)

-or-

Providers enrolling for the sole purpose of becoming an ordering, referring, prescribing provider.

Do not enroll as a nonbilling 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 Nonbilling Individual Provider Agreement. If your intent is to be listed on fee-for-service claims you should not use this application.

For additional information, refer to the Non-billing Provider Agreement (See WAC 182-502-0006).

What documents do I need to submit?

Individual nonbilling providers must complete the Individual Nonbilling form in PDF or Word

Nonbilling groups, facilities, agencies, organizations, and institutions must complete the Organizational Nonbilling form in PDF or Word

Documentation sent to Provider Enrollment requires a document submission cover sheet. You will be prompted to complete and print the cover sheet once you have submitted your online application.

Do not send double-sided documentation.

What should I know before I start my online application?

You must send all required documentation noted above with signatures. At the end of the application process, you will be given instructions for sending the necessary documents.

Once you have completed step one of the application you will be given a 16-digit application ID number. Write this number down in case you need to save and access your application at a later time. The online application has up to 18 steps. If you do not have time to complete it now you will need your application number to regain access.

Important! This is not the end of the online application. There are 16 additional steps. Click OK in the bottom right corner of the screen once you receive your application ID number to continue and complete your application. If you do not complete the application it will be dropped from the system with no record.

What enrollment type option should I select?

  • Individual: If you are enrolling as an individual provider who owns your own practice. Note: If you choose to use your Social Security number (SSN) as your tax ID you will need to update the servicing type to "Regular Individual Provider."
  • Group practice: If you are enrolling as an organization of individual practitioners who offer services.
  • Fac/agncy/orgn/inst: If you are enrolling as a facility, agency, organization, or institution.

How can I get back into my online enrollment application?

If you started an online enrollment but have not completed the required steps, you may track your enrollment application* by using your 16-digit application ID and the Social Security number (SSN) or Federal Employer Identification Number (FEIN) you entered in step one of your application. This allows you to complete the enrollment and submit it for review and approval.

What do I do after I submit my online application?

  • Enter your 16-digit application ID number then print the document submission cover sheet and attach it as the first page to all required documentation.
  • Fax your documentation to the number on the document submission cover sheet.
  • All forms and documentation must be received to complete the review and verification of your application.

Who do I contact for assistance?

For questions or assistance with your application please contact Provider Enrollment at 1-800-562-3022, ext. 16137 or submit a help request.

Contact

Provider enrollment
Phone: 1-800-562-3022 Ext 16137