The Washington Out of Country Provider Account Application is an online form used to register as an out-of-country provider of medical services in the state of Washington. It is intended for medical providers who plan to provide services to Washington residents outside the state. It allows for providers to register for an account that will enable them to bill Washington Medicaid for out-of-country services. There are two types of Washington Out of Country Provider Account Applications: one for individual providers and one for group providers. The individual application requires information such as the provider's name, address, license information, and type of services offered. The group application is similar, but it requires additional information such as group name, tax ID, and number of members. Both applications require the provider to agree to the terms and conditions of the application and submit payment.