Washington Provider Enrollment - Frequently Asked Questions
Who needs to enroll in Washington Medicaid?
Effective for dates of service on and after July 1, 2012, the Apple Health (Medicaid) program administered by the Health Care Authority (HCA) will require any ordering, referring, or prescribing provider to enroll as participating providers with Medicaid.
Why is HCA requiring these providers to become enrolled?
HCA is complying with federal regulation 42 CFR 455.410, regarding the enrollment and screening of providers.
How will providers report the ordering, referring, or prescribing provider for a billed service?
HCA is requiring all claims for items and services that were ordered, prescribed, or referred to contain the NPI of the licensed health care professional ordering, prescribing or referring the service in a designated field. If you are unsure where to enter the NPI on the claim, review the ProviderOne Billing and Resource Guide for more information.
What if the provider is enrolled with another state’s Medicaid program? Will the provider need to enroll in all the states in which he or she provides services?
Enrollment in another state’s Medicaid program does not exempt a provider from becoming an Apple Health provider in Washington. Providers are required to enroll in each state where they provide services.
If Apple Health is secondary to a commercial insurance, would the claim be accepted without the enrolled ordering, prescribing, or referring provider requirement?
No. The enrollment requirement also applies if Apple Health is being billed as the secondary to a commercial insurance
Does a provider have to be enrolled as a participating provider or can he or she be enrolled only as an ordering, prescribing, or referring provider?
Yes. Any enrolled provider who is ordering, prescribing, or referring services would have to be seeing the client and is therefore automatically a participating provider and is considered as such. While providers do have the right to limit the number of Apple Health clients they serve, they are subject to all Medicaid rules.
Who should I contact with further questions?
To find out if you are already an Apple Health (Medicaid) provider, please call Provider Enrollment at 1-800-562-3022 Ext 16137. For questions concerning why Envolve requires providers to take this action, please contact Envolve Customer Service at (888) 282-6025.