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  • Molina Healthcare Of Washington Epsdt Form

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Intwa/wsprt/default.asp Ship To Name: Company: Street: PO Box #: Suite: City: State: Zip Code: Fax #: Telephone #: Form Name Form Order Number 13-683 13-683A 13-683B 13-683C 13-683D 13-683E 13-684 13-684A 13-684B 13-684C 13-685 13-685A 13-685B 13-685C 13-685D 13-686 13-686A 13-686B Infancy 2 - 4 Weeks Infancy 2 Months Infancy 4 Months Infancy 6 Months Infancy 9 Months Infancy 12 Months Early Childhood 18 Months Early Childhood 2 Years Early Childhood 3 Years Early Childhood 4 Years Late.

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Molina's BHSO health plan is designed to provide Washington Apple Health (Medicaid) Fee-for-service members with mental health and substance use disorder treatment services. Together with our behavioral health providers, our goal is to help keep you well. Learn more.

As always, you may contact Molina Healthcare of Washington by calling 855-322-4082.

Contact Information Provider ServicesPhone (855) 322-4082 Fax (425) 424-1172 / (877) 814-0342ClaimsPhone (855) 322-4082 PO Box 22612 Long Beach, CA 90801Member ServicesPhone (800) 869-7165 Fax (800) 816-3778Mailing AddressMolina Healthcare of Washington PO Box 4004 Bothell, WA 98041-40041 more row • 26 Jan 2023

The phone number is (888) 275-8750 (TTY 711) / (866) 648-3537 (Spanish).

Submit Claims to Molina through your EDI clearinghouse using Payer ID 38336, refer to our website .MolinaHealthcare.com for additional information.

Molina's BHSO health plan is designed to provide Washington Apple Health (Medicaid) Fee-for-service members with mental health and substance use disorder treatment services. Together with our behavioral health providers, our goal is to help keep you well. Learn more.

Molina accepted locally for Medicaid as Community Health Plan of Washington departs. As of the start of the new year, Community Health Plan of Washington(CHPW) is no longer operating in Grays Harbor County. In response to their departure, GHCH says that they have partnered with Molina as of January 1st.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232