CORE PROVIDER AGREEMENT The Department of Social and Health Services (the department) administers medical assistance and medical care programs for eligible clients. The department provides medical.
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How to fill out the Dshs Core Provider Agreement Form online
The Dshs Core Provider Agreement Form is essential for providers seeking to enroll in medical assistance programs managed by the Department of Social and Health Services. This guide offers clear, step-by-step instructions to fill out the form online effectively.
Follow the steps to complete the Dshs Core Provider Agreement Form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the identifying information in Section I. Enter the owner’s name, effective date, business name, and contact details such as the business phone and mailing address.
- Next, complete the business's physical address and type of practice. Specify the provider’s specialty and professional license number.
- In Section II, fill in the details of each provider practicing under the business name, including their name, license number, and relevant identification numbers.
- Proceed to complete questions related to criminal offenses and debarment status in Section III, ensuring full transparency in disclosures.
- Review all entered information for accuracy, ensuring compliance with federal and state requirements as detailed in the agreement.
- Once all sections are completed, save the changes. You may choose to download, print, or share the form as needed.
Complete your Dshs Core Provider Agreement Form online to ensure a smooth enrollment process.
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Get answers to your most pressing questions about US Legal Forms API.
Does Washington Medicaid accept paper claims?
Please note that you can submit electronic or paper claims. CHPW accepts electronic claims via the Availity Clearinghouse.
What is the phone number for Washington Medicaid member services?
Call the Health Care Authority at 1-800-562-3022 (TRS: 711).
What is the payer ID for Apple Health in Washington state?
Submit Claims to Molina through your EDI clearinghouse using Payer ID 38336, refer to our website .molinahealthcare.com/providers/common/medicaid/ediera/edi/benefits.aspx for additional information.
What is the phone number for provider one in Washington state?
You may contact the Medicaid Purchasing Administration's Customer Service Center at 1-800-562-3022. (or TTY at 1-800-848-5429) or online at Washington State Medicaid Customer Service.
What is the phone number for provider one Washington State?
You may contact the Medicaid Purchasing Administration's Customer Service Center at 1-800-562-3022. (or TTY at 1-800-848-5429) or online at Washington State Medicaid Customer Service.
How do I contact DSHS Washington?
Latest News. Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service.
What is Washington Medicaid timely filing limit?
Timely Filing Guidelines: accepted for payment after 365 days from the date of service. When Coordinated Care is the secondary payer, claims must be received within 365 calendar days from the date of disposition (final determination) of the primary payer. notification of payment or denial is issued.
What is provider one in Washington state?
ProviderOne means the State Medicaid Authority's Medicaid Management Information System. ProviderOne means the Washington State consolidated single payment system for Medicaid, medical and similar health care provider claims.
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