Washington Provider Payment Account Change Form is a document used to update and maintain payment information for providers in the Washington State Health Care Authority (HCA). This form is used to update the payment account information in the HCA's provider payment system. It enables providers to update their banking information, change the payment method (e.g. direct deposit or check), or make other changes to their payment account information. There are two types of Washington Provider Payment Account Change Form: one for providers registered with the HCA and one for providers not registered with the HCA. Both forms must be filled out and submitted electronically to the HCA in order to make changes to the provider's payment account information.
Washington Provider Payment Account Change Form
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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
Please use CHPW's Payer Identifier: CHPWA.
Medical Bills must be filed within 12 months of the date of service for all services rendered in Washington.
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.
ProviderOne is the computer system that coordinates with the health plans. It also sends you letters and handbooks. The number on the card is your ProviderOne client number.
Apple Health is the name for Medicaid in Washington.
Go to .Lni.wa.gov/Verify, select the option that applies to you, and search by name. To change your address online, just put in your information and make selections ingly. Update your mailing address, phone number, and email address. Repeat for each of your licenses and certificates.
Select ClaimRemedi, Billing Agent/Clearinghouse ProviderOne ID: 2010950.
