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.
On this page
Compile your application materials then proceed to ProviderOne.
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)
Providers enrolling for the sole purpose of becoming an ordering, referring, prescribing provider.
For additional information, refer to the Nonbilling Provider Agreement (See WAC 182-502-0006).
What documents do I need to submit?
- Individual nonbilling providers must complete the Individual Nonbilling form (PDF).
- Nonbilling groups, facilities, agencies, organizations, and institutions must complete the Organizational Nonbilling form (PDF).
How do I submit the required documents?
Download our instructions for how to upload attachments in ProviderOne.
What should I know before I start my online application?
For individual nonbilling providers, the enrolling provider must complete and sign the individual nonbilling form.
For nonbilling groups, facilities, agencies, organizations and institutions, the required organizational nonbilling form must be completed and signed by the individual listed as a contact or disclosure in either step 2 (add locations) or step 4 (ownership & managing/controlling interest details) of the Business Process Wizard (BPW).
Once you have completed step one of the application you will be given a 14-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 17 steps. If you do not have time to complete the application in one sitting, you will need your application number to regain access at a later date.
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.
What enrollment type option should I select?
- Individual: this enrollment needs a type 1 (individual NPI) with a Social Security Number (SSN).
- Group practice: this enrollment needs a type 2 (organizational NPI) with EIN/FEIN/Tax ID.
- Fac/agncy/orgn/inst: this enrollment can use either type 1 (individual NPI) with SSN or type 2 (organizational NPI) with EIN/FEIN/Tax ID.
What billing type and agency should I select?
For help, view our instructions for adding Billing Type and Available Agencies.
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 14-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.
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.
Phones are open on Tuesdays and Thursdays from 7:30 a.m. to 4:30 p.m. (closed from 12:00 p.m. to 1:00 p.m.)
Phones are closed on Mondays, Wednesdays, and Fridays.
Phones are open: Tuesdays and Thursdays from 7:30 a.m. to 4:30 p.m. (Closed from noon to 1 p.m.)
Phones are closed: Mondays, Wednesdays, and Fridays.