Get Wac 182 502 0160

The WAC 182 502 0160 is an important agreement form between clients and providers for billing healthcare services not covered by Medicaid or other healthcare benefits. This guide provides clear, step-by-step instructions to help you fill out this form online efficiently and accurately.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the client's printed name in the designated field. This should be the full name of the individual receiving the healthcare services.
3. Input the client's ID number as provided by the Health Care Authority (HCA). This is essential for identification purposes.
4. Provide the provider's printed name in the section designated for the healthcare provider or institution. Ensure that the name matches the registered name with HCA.
5. Enter the provider number, which is a unique identifier assigned to the provider by HCA or the managed care organization (MCO).
6. Complete the table detailing specific services to be provided, including anticipated dates of service, billing codes, amounts to be paid, and reasons for billing. Include all relevant information for each service.
7. Each party, including the client, provider, and interpreter (if applicable), must sign and date the form in the appropriate signature sections.
8. After reviewing all information for accuracy, you can save your changes, download the completed form, print it for your records, or share it as needed.

Complete the WAC 182 502 0160 form online today to ensure your healthcare services are processed efficiently.