Manuals, Forms and Resources
COVID-19 Billing Info & FAQs
For HCA's provider guidance, visit the links below, found on HCA's COVID-19 web page.
- Billing for COVID-19 Evaluation and Testing (PDF)
- Apple Health Coverage for telemedicine services (PDF)
- Clinical Policy and Billing FAQs
- HCA's Physician Related Services Billing Guide
- HCA's Emergency Covid-19 Fee Schedule
In response to the COVID-19 pandemic, the HCA has purchased a limited number of licenses for Zoom, a video conferencing technology that helps health care providers continue seeing patients without a physical encounter. See HCA's Zoom License Request page for details and an application.
For more provider-specific information regarding coronavirus, please visit our Coronavirus Information web page.
- Provider Manual for Medicaid & Foster Care (PDF)
- Benefits Grid - Washington Apple Health (PDF)
- Claims Billing Cheat Sheet (PDF)
- HEDIS Guides
- Sport Physical to EPSDT Visit Tool (PDF)
- Prior Authorization Guide for Integrated Managed Care (IMC) and Behavioral Health Services Only (BHSO) (PDF)
- Provider Prior Authorization Reference Guide (PDF)
- Provider Quick Reference Guide (PDF)
- Apple Health Applied Behavioral Analysis Program Billing Guide (PDF) - behavioral
- Appeal Form for Member Authorized Representative (PDF)
- Applied Behavioral Analysis Prior Authorization form (PDF) - behavioral
- BioPharmacy/Buy-Bill Prior Authorization Form (PDF)
- Coordinated Care's External Critical Incidents Notification Form (PDF)
- Exception to the Rule (ETR) – Medical (PDF)
- Hysterectomy Consent Form (PDF)
- Notification of Pregnancy (NOP) – Provider form (PDF)
- Ophthalmology Pre-Authorization Request Form (PDF)
- Outpatient/Inpatient Behavioral Health Service Authorization Request Form (PDF) - behavioral
- Outpatient Physchological Testing Prior Authorization form (PDF) - behavioral
- Ownership and Controls Disclosure Form (PDF)
- PACT Notification and Continuation of Service Request (PDF)
- Prior Authorization: Electroconvulsive Therapy (ECT) (PDF) - behavioral
- Prior Authorization/Referral Form – Inpatient (PDF) - medical and behavioral
- Prior Authorization Form – Outpatient (PDF) - medical and behavioral
- Prior Authorization Form – Transcranial Magnetic Stimulation Initial Request form (PDF) - behavioral
- Provider Demographic Change Form (PDF)
- Provider Request for Breast Pump Form for Nursing Mother
- Stage 2 Bariatric Surgery Request (PDF)
- Sterilization Consent Form (PDF)
- WISe Services Notification Form (PDF)
- W-9 Form (PDF)
BH Levels of Care Sheet
Collaborative Care is a specific type of integrated care where medical providers and behavioral health providers work together to address behavioral health conditions, including mental health and substance use disorders.
- Collaborative Care is intended to enhance usual primary care by adding two key services:
Care management support for patients receiving behavioral health treatment; and
- Regular psychiatric consultation with the primary care team, particularly clients whose conditions are not improving. (WAC 182-531-0425)
Completing the Washington Health Care Authority's (HCA) Attestation form is required for providers to indicate they meet the standards. The form is found on HCA's Forms and Publications page on their web site, or by searching for 13-0017.
The completed attestation form needs to be sent to the HCA at firstname.lastname@example.org before billing for these codes.
- Advance Directives and POLST
- Contraception Coverage Fact Sheet (PDF)
- Discharge Planning and Inpatient Utilization Management: 1-844-208-8885
- Down Syndrome Support Networks and Programs for Families (PDF)
- HPV Cancer Prevention: The Importance of the HPV Vaccine
- Immunization Coverage Rate Report (PDF)
- Lead Poisoning Prevention
- Medically Intensive Children's Program (MICP) flyer - English (PDF)
- Medically Intensive Children's Program (MICP) flyer - Spanish (PDF)
- Member Rights and Responsibilities
- Partnership Access Line (PDF)
- Smoking Cessation Program Description
- Transplant Check List (PDF)
Providers can request Provider Policies and Procedures by contacting our Provider Services Department at 1-877-644-4613 (TDD/TTY 1-866-862-9380) and a representative will assist you.
Ambetter Manuals & Forms
For Ambetter information, please visit our Ambetter website.