Resources

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 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

• Encounter Data Reporting Guide
  Requirements and guidelines for reporting health care services
• Effective Date Change Request form (Word)
• How to register an NPI
• 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

HCA guidance documents/FAQs

• Behavioral health services only program
• Behavioral health - administrative service organization
• Appeal rights
• IMC inpatient FAQ
  • Behavioral health - administrative service organization/behavioral health organization agreement for nonresident individuals (updated March 2020)
• 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

• Email contact list
• MCO contact list (Excel workbook)
• Apple Health (managed care) service area matrix
• Apple Health (managed care) service area map
• 2020 combined MCO prior authorization summary (updated June 2020)