Washington Medical Payment Guidance is a set of regulations and guidelines provided by the Washington State Health Care Authority (HCA) to ensure that the payments made to health care providers are made in a fair and equitable manner. It is designed to protect health care providers from unfair practices by insurers, and to ensure that consumers receive the medical care they need. Washington Medical Payment Guidance covers all types of medical services, including primary care, specialty care, hospital stays, and inpatient and outpatient services. The guidance includes information on billing and payment practices, provider participation in payment plans, and provider reimbursement. There are three main types of Washington Medical Payment Guidance: Fee-For-Service (FFS) Guidance, Managed Care Organizations (CMOS) Guidance, and Specialty Care Guidance. Fee-For-Service (FFS) Guidance is designed to ensure that health care providers are paid fairly for services rendered, regardless of the patient’s insurance coverage. Managed Care Organizations (CMOS) Guidance is designed to ensure that health care providers are reimbursed appropriately when they participate in a managed care plan. Specialty Care Guidance is designed to ensure that health care providers are reimbursed appropriately when they provide specialty services.
Washington Medical Payment Guidance
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FAQ
Yes. To bill Medi-Cal, a provider must complete the appropriate enrollment forms. For questions about which forms to use, contact the Out-of-State Provider Unit at (916) 636-1960. If a provider chooses not to enroll, they may bill the patient.
What Is Apple Health? Apple Health is the name for Medicaid in Washington. Apple Health is free or low-cost health insurance coverage for those who qualify. Covered services include primary care, emergency visits, maternity services, pediatric care, dental services, vision care, prescription medications and more.
Clearinghouse Provider One ID: 2121991 ProviderOne displays the Associate Billing Agent/Clearinghouse page.
Please use CHPW's Payer Identifier: CHPWA.
Learn more. 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.
A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.
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.
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.
