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The following resources are available to help managed care organizations (MCO) and administrative services organizations (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 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.
- 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
- Behavioral health services only program
- Behavioral health - administrative service organization
- Appeal rights
- IMC inpatient 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
- 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)