Get Wa Hca 13-835 2016-2025

The WA HCA 13-835 form is essential for authorizing various healthcare services in Washington. This guide provides clear and supportive instructions on how to fill out the form accurately online, ensuring all necessary information is gathered effectively.

Follow the steps to complete the WA HCA 13-835 form online.

1. Click ‘Get Form’ button to obtain the WA HCA 13-835 form and open it in your document management tool.
2. Complete the 'Org' field by entering the number that corresponds to the program or unit for the request, such as 501 for Dental or 502 for Durable Medical Equipment.
3. In the 'Service Type' field, enter the letter(s) in all capital letters that represent the service type you are requesting, based on your selection in the 'Org' field.
4. Enter the patient's name in the 'Name' field, providing the last name, first name, and middle initial as required.
5. Fill in the 'Client ID' field with the nine-digit client ID followed by 'WA'. If unknown, contact HCA for assistance.
6. Specify the 'Living Arrangements' of the client, indicating whether they reside at home, in a group home, or another type of facility.
7. If applicable, enter the 'Reference Auth #' if you are requesting a change or extension to a current authorization.
8. Input the 'Requesting NPI #' and 'Billing NPI #' as required, providing the 10-digit numbers issued by CMS for your providers.
9. Provide the 'Service Start Date', indicating when the requested service is planned to begin, if known.
10. In the 'Description of service being requested' field, enter a brief description of the service you are seeking authorization for, such as 'manual wheelchair'.
11. Complete the necessary coding and quantity fields, including 'National Code' and '# Units/Days Requested', ensuring to reference program-specific guidelines for accuracy.
12. Enter the 'Diagnosis Code' and its respective name, along with any comments that may be relevant in the 'Comments' field.
13. Review all entered information for accuracy, then save your changes.
14. Once completed, download or print the form as needed, or share it with the necessary parties for submission.

Take the time to fill out the WA HCA 13-835 form online to ensure timely authorization for services.