For those affected by flooding in Washington
If you or someone you know has been displaced, needs medical or behavioral health support, or is navigating interruptions to health coverage or services, resources are available to help.
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