Manuals, Forms and Resources

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.

Apple Health (Medicaid) Manual and Guides

• Provider Manual for Medicaid, Foster Care & Apple Health Expansion (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

Apple Health (Medicaid) Forms

• Appeal Form for Member Authorized Representative (PDF)
• Apple Health Expansion In-Person Interpreter Request (PDF)
• Form 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)

Behavioral Health

BH Levels of Care Sheet

Fact Sheets

ADHD

• ADHD Fact Sheet (PDF)
• ADHD Toolkit (PDF)

Anxiety

• Anxiety Fact Sheet (PDF)
• Anxiety Toolkit (PDF)

Depression

• Depression Fact Sheet (PDF)
• Depression Toolkit (PDF)

Substance Use

• Substance Use Fact Sheet (PDF)
• Substance Use Toolkit (PDF)

Collaborative Care

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.

1. Collaborative Care is intended to enhance usual primary care by adding two key services:
   Care management support for patients receiving behavioral health treatment; and
2. 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 providerenrollment@hca.wa.gov before billing for these codes.