CHPW would like to remind providers that eligible Managed Care Organization (MCO)-contracted providers are required to enroll their National Provider Identifier (NPI) with the Washington State Health Care Authority (HCA); or the provider must have an approved application on file with the state, dated on or before the date they begin seeing CHPW members.
Providers who have enrolled their NPI with the HCA can be paid for covered services, supplies, and equipment rendered to eligible Washington Apple Health Integrated Managed Care, Behavioral Health Services Only, and Apple Health Expansion clients.
Please be advised that in order for your encounters and claims to be accepted and eligible claims to be paid, your NPI must be actively enrolled with the HCA; or you must have an approved application on file with the state, dated on or before the date you begin seeing CHPW members; or you must have a nonbilling agreement with the HCA. If you do not bill with a registered NPI, CHPW will deny claims and, if necessary, recoup paid claims.
Washington Administrative Code (WAC) allows the following option for providers who do not bill fee-for-service (FFS) Medicaid: Enroll with the agency (HCA) as a nonbilling provider. A completed nonbilling agreement registers your NPI with (makes your NPI known to) the state.
The Core Provider Agreement (CPA)/nonbilling agreement requirement applies only to MCO-contracted providers who bill FFS through the state’s ProviderOne system.
Please read our Core Provider Agreement and NPI Status for Medicaid Services FAQ for more information. Updates to the FAQ for 2025 include: MCOs cannot pay for services if a plan-contracted NPI is not active or pending with the HCA at the time of claim submission for the date of service.
