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Prior authorization, claims, and billing

As an enrolled Apple Health (Medicaid) provider, you determine client eligibility, submit claims for eligible services, and are paid through the ProviderOne billing and claims system. In this section, learn how to request prior authorization (PA) for servicessubmit claimsaccess provider billing guides and fee schedules, and find hospital reimbursement information.

Important! ProviderOne claims submission deadlines. The deadline is every Tuesday at 5 p.m. for payment the following Monday. The data exchange with the state financial office occurs on Thursdays and Fridays. Providers may see a Friday date on their Remittance Advice.

If you are displaced or affected by wildfire, all Washington Apple Health and PEBB/SEBB medical plans are allowing prescription refills before the refill date.
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