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Washington State Dental Association

Reminder: Medicaid Claims Going Paperless Oct. 1

Effective October 1, 2016, the Health Care Authority (HCA) will accept only electronic claims for Apple Health (Medicaid) services, except under very limited circumstances.

According to the HCA, providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically. Examples of these unusual circumstances may include but are not limited to:

  • HCA notifies provider in writing that paper claims will be accepted due to ProviderOne System issues precluding acceptance of electronic claims.
  • The provider can demonstrate that the information needed for adjudication of an Apple Health (Medicaid) claim cannot be submitted electronically using the claim formats required under the ProviderOne Billing and Resource Guide.
  • The provider is experiencing a disruption in their electricity or communication connection that is outside of his or her control and is expected to last longer than two days. This exception applies only while electricity or electronic communication is disrupted.
  • Providers that have not submitted any electronic claims within the past state fiscal year (July 1, 2015 to June 30, 2016).

Providers who wish to ask for an exemption from submitting claims electronically may do so using the Request a Waiver form.

For further information regarding this changes, please contact the HCA Customer Service Center at 1-800-562-3022.

Provider Guide Updates

The Washington State Health Care Authority (HCA) recently published updates to the following Washington Apple Health provider guides:

Access to Baby and Child Dentistry (ABCD) Provider Guide

Dental-Related Services Provider Guide

All of the changes that have been made are listed at the beginning of each provider guide under the “What has changed” table. Recent changes for this quarter include billing and claim form updates. 

All updates and changes to Washington Apple Health Provider Guides and Fee Schedules are made quarterly (January 1st, April 1st, July 1st, & October 1st). 

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TAGGED: WSDA HCA, Apple Health