American Indians and Alaska Natives (AI/AN)
American Indian/Alaskan Native (AI/AN) individuals who have active Apple Health (Medicaid) benefits but are not enrolled in a managed care plan may qualify for behavioral health services.
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Who is eligible?
Members of the AI/AN community with Apple Health coverage who are not enrolled in a managed care plan are eligible for the Apple Health fee-for-service (FFS).
When an individual has behavioral health FFS coverage, fully integrated managed care (FIMC) and Behavioral Health Services Only (BHSO) will not be listed in ProviderOne.
Please see Part II of the mental health and SUD billing and policy manual for the Recovery Audit Contractors (RACS) payable under this program.
Types of care for AI/AN individuals
AI/AN individuals receiving Apple Health coverage have the choice by federal law to receive their treatment of mental health and substance use disorder (together, known as "behavioral health") either through the managed care program or through Apple Health FFS.
Please note: If AI/AN Apple Health clients are eligible to receive care at an Indian Health Service (IHS) facility, Tribal health program, or urban Indian health program, this change will not affect their ability to receive care at those programs. In addition, those programs may be able to help AI/AN clients make their choice for Apple Health coverage for behavioral health services.
How do I become an FFS-enrolled provider?
For instructions on how to enroll, visit our enroll as a provider webpage. Providers must be enrolled and have access to the ProviderOne system to submit claims. Once enrolled, providers will submit claims directly into ProviderOne.
Providers treating clients in the Apple Health fee-for-service behavioral health program will bill the state directly through the ProviderOne claims system and be paid according to the following published rate schedule:
What data will I need to submit as an FFS provider?
FFS providers will submit behavioral health data encounters into the Provider Entry Portal. The Provider Entry Portal is a database used to collect additional behavioral health data that is required by our federal partners. For assistance, view the Provider Entry Portal user guide or email FFSQuestions@hca.wa.gov.