ProviderOne Billing and Resource Guide

A complete guide for using ProviderOne.

Important! On January 1, 2017, the Health Care Authority (HCA) changed the process for managing Apple Health (Medicaid) benefits for clients with other primary health insurance. Learn about these changes.

The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff:

  • Find client eligibility for services.
  • Bill in a timely fashion.
  • Receive accurate payments for covered services.

The guide is intended to:

  • Strengthen the current instructions that apply to nearly all types of providers.
  • Respond to provider requests for more step-by-step reference materials for ProviderOne.

Paperless billing has arrived!

On October 1, 2016, the Health Care Authority implemented a paperless billing policy where all Apple Health (Medicaid) providers (excluding Tribal billing offices) are required to submit electronic claims for Apple Health (Medicaid) services. Providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically. 

The agency's Provider Relations team hosted two webinars focused on billing electronically through the ProviderOne portal to assist those providers who have not transitioned to electronic billing. The links to these webinars, the waiver form, and an FAQ on the paperless policy can be accessed below:

Guide updated to reflect paperless billing

As of October 1, 2016, the ProviderOne Billing and Resource Guide no longer contains references to paper claim billing. It is now focused solely on electronic claim submission.

ProviderOne Billing and Resource Guide (complete guide)

Appendixes

The appendixes below are included in the complete guide. They are presented here for your convenience.

Appendix A - Use interactive voice response (IVR) to verify eligibility

Appendix B - Verifying eligibility using a magnetic card reader or MEV service

Appendix C - Managed care organizations (MCOs)

Appendix D - Casualty claims and health insurance claims

Appendix E - Benefit services packages

Appendix F - Instructions to fill out the General Information for Authorization Request form

Appendix G - How to check status of an authorization

Appendix H - Cover sheets for backup documentation

Appendix I - Taxonomy and ProviderOne 

Appendix J - Medicare crossover claim payment methodology

Appendix K - Checking claim status with IVR 

Appendix L - Checking warrants with IVR

Please note: Appendix I, J, and K have been renamed to new topics and the previous material on paper claims has been moved to the new Paper Claim Billing Resource. See Paperless billing has arrived! for more details.

Provider billing guides and fee schedules

Use the provider billing guides and rates and fee schedules as companions to the billing and resource guide. You will use these regularly as you submit your claims.

Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. For best results, bookmark this page so that you are always using the most up-to-date version of the guide.

Contact

Medical Assistance Customer Service Center (MACSC)
Online: Web form
Phone: 1-800-562-3022