Jan
06
2025
Discovery log number
00436
Discovery description
We have become aware of a Remittance Advice reconciliation issue that occurred during last week’s payment and remittance cycle on January 1-3, 2025. To be clear, this is a remittance issue, not a payment issue. While we are still diagnosing the root cause and remediation, we want to provide assurance that payments made last week on January 3, were accurate. Impacted providers received a Remittance Advice showing a lower payment amount than the actual payment amount received by the providers. Once remediation activities have been defined, specific outreach will be conducted with impacted providers.
Please submit additional questions to MMISHelp@hca.wa.gov
Date reported
ETA
Provider impact
All Providers
Workaround
Please submit additional questions to MMISHelp@hca.wa.gov
HCMACS Connect Program
The Health Care Authority (HCA) is participating in the Health Care Management and Coordination System (HCMACS) enterprise electronic health record (EHR) implementation to enhance health care services for providers and patients. Learn about the background of the Connect Program and next steps.
On this page
Purpose
Washington’s Apple Health (Medicaid) population of nearly 2 million members frequently use services provided by HCA, the Department of Social and Health Services (DSHS), and the Department of Corrections (DOC). HCA will use the HCMACS Enterprise EHR solution which is comprised of Epic Health systems with shared governance and resources to support this population. As part of the HCMACS rollout, HCA will be offering Epic Connect to Apple Health (Medicaid) providers in Q3 of 2027.
This will improve health care coordination between providers and allow the state to provide high-quality care more effectively for Apple Health clients being served by community providers.
The HCMACS Connect Program will allow improvements in areas such as:
- Infant case management.
- Maternity support services.
- Long-term care and support services.
- Behavioral health.
- Tribal health.
- Prior authorization.
- Utilization management.
- And more.
Model and functionality
Contracted providers will have access to the HCMACS Enterprise EHR Epic platform via the HCMACS Connect Program. This model allows smaller health care organizations to access the full capabilities of the HCMACS Epic EHR system.
This model enables several benefits, including:
- Improved patient care through streamlined workflows.
- Enhanced data access.
- Strong interoperability with other health care systems.
- Robust reporting and analytics capabilities.
- Highly customizable solutions.
- Patient engagement features through a patient portal.
- Reduced administrative tasks by facilitating seamless data exchange between different. departments within a health care organization.
This solution allows data to be seamlessly shared between providers using similar and dissimilar systems. The extent of data sharing capabilities will vary from system to system. Using the same enterprise EHR exponentially improves information sharing and care delivery.
HCA intends to implement HCMACS Connect with identified providers in cohorts. The initial cohort will be focused on Indian health care providers, behavioral health and substance use disorder (SUD) providers. Additional cohorts will include rural hospitals, jails, long-term care, and crisis responders. Providers will be prioritized based on Apple Health clients supported.
Next steps
The HCMACS Connect Program is currently focused on engagement with Indian health care providers and behavioral health providers to assess needs, identify requirements, outline readiness activities, and finalize contracts. This program works closely with the HCMACS Program and other projects.
Implementation work will kick off in Q2 2026. HCA providers will go live with the system Q3 2027. For more information on the efforts and timeline, check out the HCMACS Enterprise EHR Roadmap.
2025
The State Plan is the officially recognized statement describing the nature and scope of Washington State's Medicaid program.
| Title | SPA packet number | Date approved |
|---|---|---|
| Certified Peer Specialists | 25-0001 | 04/30/2025 |
| Pre-release Reentry Services for Juveniles | 25-0003-A | 06/03/2025 |
| Reentry Services for Juveniles | 25-0003-B | 06/25/2025 |
| Reentry Services | 25-0003 | 06/24/2025 |
| Physician Services Updates | 25-0005 | 09/05/2025 |
| Dental Therapists | 25-0006 | 05/28/2025 |
| January 2025 Fee Schedule Updates | 25-0007 | 04/23/2025 |
| Alternative Benefits Package | 25-0008 | 07/02/2025 |
| Add Psychological Associates and Rename Certified Peer Specialists and Trainees | 25-0010 | 11/3/2025 |
| HCBS Rates | 25-0011 | 04/20/2025 |
| Update Inpatient DRG LARC Payment | 25-0012 | 06/26/2025 |
| Managed Care Reentry Services | 25-0013 | 07/21/2025 |
| April 2025 Fee Schedule Updates | 25-0014 | 08/18/2025 |
| Clinic Benefits Update | 25-0015 | 06/13/2025 |
| Remove Ancillary Services From Admin Day Rate | 25-0017 | 10/30/2025 |
| MAT-MOUD Updates | 25-0018 | 01/08/2026 |
| July 2025 Fee Schedule Updates | 25-0020 | 11/25/2025 |
| Recovery Audit Contractors | 25-0021 | 11/21/2025 |
| Nursing Facility Rates | 25-0022 | 12/15/2025 |
| HCBS-Personal Care Services Rates | 25-0023 | 12/1/2025 |
Provider Alerts 2025
Emails relevant to rules, Medicaid provider guides, and policies.
| Date | Provider Alert |
|---|---|
| 01/09/2025 | MES and CRT – removal of prior authorization for certain HCPCS codes |
| 01/21/2025 | Applied Behavior Analysis (ABA) billing guide updates – Effective February 1, 2025 |
| 01/28/2025 | Enhanced payments for trauma care |
| 01/29/2025 | Home Health providers – Electronic Visit Verification (EVV) update |
| 02/19/2025 | Kidney Center Services Billing Guide, Effective 02/19/2025 |
| 02/28/2025 | Birth doula billing guide updates eff. February 28, 2025 |
| 02/28/2025 | Physicians billing guide updates |
| 03/10/2025 | New taxonomies for licensed mental health associates |
| 03/20/2025 | Quarterly Billing Guide Updates, Effective 4/1/2025 |
| 03/20/2025 | Medical Equipment and Supplies – Compression garments and bathroom equipment |
| 03/28/2025 | Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List update for April 1, 2025 |
| 04/04/2025 | Home Health Providers – Electronic Visit Verification (EVV) Update |
| 04/10/2025 | PM&R and LTAC prior authorization (PA) requests |
| 04/10/2025 | New Community Health Worker (CHW) Services Billing Guide |
| 04/23/2025 | Reminder EPSDT Well-Child Program billing requirements take effect July 1, 2025 |
| 04/24/2025 | New Reentry Targeted Case Management (rTCM) Billing Guide, eff. July 1, 2025 |
| 04/25/2025 | Home Health Providers – Electronic Visit Verification (EVV) Webinar Update |
| 05/15/2025 |
Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List update for May 1, 2025 |
| 05/20/2025 |
Medical Equipment and Supplies – Discontinued DME email inbox, effective June 1, 2025 |
| 05/22/2025 |
Discontinued EPA Number 870 for Evidence-Based Practice; effective July 1, 2025 |
| 06/03/2025 |
Reminder - PM&R and LTAC prior authorization (PA) requests |
| 06/16/2025 |
Community Health Worker (CHW) Services Billing Guide updates, Eff 7/1/2025 |
| 06/16/2025 |
Quarterly Billing Guide Updates, Effective 7/1/2025 |
| 06/17/2025 | EPSDT billing guide reminder |
| 06/25/2025 | Final reminder EPSDT Well-child program billing requirements take effect 7/1/25 |
| 06/26/2025 | Changes to Apple Health (Medicaid) Audio-Only Procedure Code Lists, eff. 7/1/25 |
| 07/01/2025 | Apple Health recognizes certified anesthesiologist assistants as servicing providers, effective July 1, 2025 |
| 07/23/2025 | Hospital ancillary services |
| 08/19/2025 | Interpreter Services Billing Guide update eff August 15, 2025 |
| 08/27/2025 | Hospice Services Billing Guide Update, Effective September 1, 2025 |
| 09/03/2025 | Private Duty Nursing - Overtime clarification |
| 09/22/2025 | Quarterly Billing Guide Updates, Effective 10/1/2025 |
| 09/26/2025 | New Health-Related Social Needs (HRSN) Services Billing Guide effective 10/1/2025 |
| 10/1/2025 | New Reentry Services Billing Guide, eff. October 1, 2025 |
| 10/2/2025 |
EPSDT Well-Child Program Name Change, Effective 10-1-25 |
| 10/13/2025 | Physician standby services discontinued 10/1/2025 |
| 10/17/2025 |
Updated Medicare telehealth guidance |
| 10/31/2025 | Substance-Using Pregnant People (SUPP), adding CPT code 99239, eff. 10/1/25 |
| 12/9/2025 |
Prescription Drug Expedited Authorization (EA) List eff. January 1, 2026 |
| 12/12/2025 |
New billing requirements for associate-level providers, effective 1-1-2026 |
| 12/17/2025 |
Updates to Family Planning Billing Guide, Eff January 1, 2026 |
| 12/17/2025 |
Quarterly Billing Guide Updates, Effective 01/01/2026 |
| 12/29/2025 |
Collaborative Care Management HCPCS code G0512 ending on 12/31/2025 |
| 12/30/2025 |
Dental anesthesia codes and prior authorization updates, effective January 1, 2026 |