Core Provider Agreement Washington State

Before you start the app, select the type of provider that fits your situation (see below). Hospitals and providers must re-validate each number of the National Practitioner Identification (CPI) within five years of the date of their pre-validation. The revalidation includes filling in and downloading an updated basic vendor agreement, a clearance statement, the W9 IRS form and additional documents, depending on the type of installation or provider. The validation page and instructions are in www.hca.wa.gov/billers-providers-partners/apple-health-medicaid-providers/revalidation. Nonbilling applications are intended for providers that provide services to Apple Health (Medicaid) customers as part of a management entity or public health organization (not under the Apple Health Paid Program) – or providers that exclusively connect to the goal of becoming an order, reference and prescription provider. The Health Care Authority (HCA) recently contacted WSHA about the revalidation process required by the Federal Government. Hospitals and providers that do not complete the revalidation should expect that their Basic Medicaid Provider Agreement will be deactivated and payment interruptions will be deactivated. WSHA recently contacted several hospitals that HCA said had not yet responded to revalidation notifications and were threatened with deactivation. HCA informed WSHA that ProviderOne was not in a position to search for the date of the revalidation of establishments and suppliers. Entities and suppliers can contact ProviderEnrollment@hca.wa.gov or call 1-800-562-3022 Extension 16137 if they feel they can be properly revalidated but have not received a notification or if they have any questions about the process. (Andrew Busz, andrewb@wsha.org).

All billing providers must complete and sign a basic supplier agreement with the Agency and other necessary documents. This application procedure is for licensed health professionals who wish to register with the Health Care Authority (HCA) as an enforcement provider who practices within a group or organization. The group or organization must be registered with HCA and have a basic supplier agreement with the Agency. Are you interested in an Apple Health (Medicaid) provider or need to know if you are registered? Use this chart to compare the types of providers above with the registration type options in ProviderOne.

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