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Resources
The following resources are available to help managed care organizations (MCO) and behavioral health administrative services organizations (BH-ASO) providing services for Apple Health (Medicaid) managed care clients.
Model contracts and general guidance
- Model managed care contracts
Model managed care contracts are used by MCOs in providing access to quality health care services for eligible Washington State citizens. - Patient Review and Coordination Managed Care Guide
This guide is for MCOs in developing and managing a Patient Review and Coordination (PRC) Program. - ProviderOne 5010 companion guides
Use these guides in conjunction with the HIPAA National Electronic Data Interchange Implementation Guides.
Additional resources
- Claims billing - encounter data
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- Encounter Data Reporting Guide
Requirements and guidelines for reporting health care services - Effective Date Change Request form
- How to enroll an NPI (FAQ for licensed behavioral health agencies to assist with billing Integrated Managed Care (IMC), updated February 2024)
- Instructions to enroll individual servicing only providers
- Integrated managed care (IMC) SERI, NPI, and taxonomies (FAQ)
- SERI interim guidance
- Apple Health (Medicaid)-covered drug screen/urinalysis testing (monitors the progress of people receiving treatment for substance use disorder (SUD))
- Billing and information technology: a toolkit for behavioral health agencies
- Encounter Data Reporting Guide
- HCA guidance documents/FAQs
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- Behavioral health services only program
- Behavioral health - administrative service organization
- Appeal rights
- IMC inpatient FAQ
- Involuntary and voluntary inpatient hospital services FAQ
- Guide on Address Confidentiality Program and how to enroll or switch to a managed care organization (MCO)
- Integrated managed care behavioral health billing for dual-eligible clients
- Prior authorizations and correctional facilities release to SUD residential facilities
- MCO/ASO information
Contact
For IMC-specific questions
Email: HCA MC programs
For BH questions
Email: HCA BH-ASO
For NPI/credentialing questions
Contact HCA Provider Enrollment via HCA support portal
For encounter data questions
Email: Encounter data
For EHRT questions
Email: Health IT