Washington Medicaid — Washington Apple Health (Medicaid)
| Program name | Washington Apple Health (Medicaid) |
|---|---|
| Provider portal | https://www.hca.wa.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Washington Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Washington
The Blue Cross Blue Shield Association licensee in Washington is Regence BlueShield (Washington). See the Regence payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Washington
The dominant commercial insurers operating in Washington, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Washington
Washington Apple Health (Medicaid) contracts with the following managed-care organizations to administer Medicaid benefits in Washington. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Washington
Noridian Healthcare Solutions, LLC is the Medicare A/B MAC for Washington: Part A and Part B fee-for-service claims from Washington go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 171 active LCDs from these contractors apply to Washington claims.
- Noridian Healthcare Solutions, LLC
A/B MAC (Part A and Part B claims); DME MAC (durable medical equipment and supplies)
- Wellpoint Federal
Home health and hospice MAC
Selected active Noridian Healthcare Solutions, LLC policies for Washington
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L38814 MolDX: Minimal Residual Disease Testing for Cancer
- L39240 Epidural Steroid Injections for Pain Management
- L38902 Wound and Ulcer Care
- L34211 Trigger Point Injections (TPI)
- L35526 B-type Natriuretic Peptide (BNP) Testing
- L38709 Computed Tomography Cerebral Perfusion Analysis (CTP)
- L40255 Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices
- L34194 Blepharoplasty, Eyelid Surgery, and Brow Lift
- L34215 Lab: Flow Cytometry
- L35136 Spinal Cord Stimulators for Chronic Pain
- L36538 Treatment of Males with Low Testosterone
- L36678 Lab: Bladder/Urothelial Tumor Markers
Equipment, home health and hospice policies that apply in Washington
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Washington billing
- RCW 48.49 (Balance Billing Protection Act, 2020)
- WAC 284-43-325 (prompt pay — 30 days electronic clean claim, 60 days paper)
- RCW 70.170 (hospital charity care and community benefit reporting)
Provider licensing & enrollment in Washington
Providers enroll via ProviderOne (HCA). Apple Health IMC MCOs credential separately; most accept CAQH ProView.
Major health systems headquartered in Washington
| Health system | Headquarters |
|---|---|
| Providence (Washington / Providence St. Joseph Health) | Renton, WA |
| UW Medicine | Seattle, WA |
| MultiCare Health System | Tacoma, WA |
| Swedish Health Services (Providence) | Seattle, WA |
| Virginia Mason Franciscan Health (CommonSpirit) | Seattle, WA |
Frequently asked questions — Washington billing
What is the Washington Medicaid program called?
Washington's Medicaid program is known as Washington Apple Health (Medicaid). Providers enroll and manage claims through the provider portal at https://www.hca.wa.gov.
What is the Washington Medicaid timely filing limit?
Washington Apple Health (Medicaid) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Washington's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Washington Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Washington Apple Health (Medicaid). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Washington?
The dominant commercial payers in Washington include Regence, Kaiser Permanente, UnitedHealthcare, Aetna, Cigna, along with the BCBS licensee Regence BlueShield (Washington). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Washington?
Washington Apple Health (Medicaid) contracts with 5 Medicaid MCOs tracked in the QuickIntell registry, including Molina Healthcare, Centene, UnitedHealthcare, Anthem (Elevance Health), Kaiser Permanente. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Washington?
Washington has 3 tracked state-level statutes that affect medical billing and RCM: RCW 48.49 (Balance Billing Protection Act, 2020); WAC 284-43-325 (prompt pay — 30 days electronic clean claim, 60 days paper); RCW 70.170 (hospital charity care and community benefit reporting). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Washington with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Washington Apple Health (Medicaid) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Washington Medicaid and the member ID card before submission.