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 and Behavioral Health Services Only clients.
Please be advised that in order for your encounters and claims to be accepted, 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 is required to 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. Non-contracted and out-of-state providers are not required to enroll with the HCA.
Updates to CHPW’s Core Provider Agreement and NPI Status for Medicaid Services FAQ for 2024 include:
- Intensive Behavioral Supportive Supervision (IBSS) providers: The paper CPA application is discontinued as of 2/12/2024 and replaced with an online CPA application through the ProviderOne system. This change is for IBSS providers only and allows the HCA to assign an Atypical Provider Identifier (API) for providers who do not have a National Provider Identifier (NPI). The HCA’s Encounter Data Reporting Guide defines API and NPI as follows:
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- Atypical Providers – Providers who do not provide medical services (e.g., non-emergency transportation, case management, environmental modifications, etc.) and are not eligible to receive a National Provider Identifier (NPI).
- National Provider Identifier (NPI) – The standard unique identifier for all healthcare providers that was implemented as a requirement of the Health Information Portability & Accountability Act (HIPAA) of 1996 (45 CFR Part 162).
The paper CPA application remains an option for other provider types (non-IBSS providers).
- Licensed behavioral health agencies: The HCA has an FAQ just for you. You can go directly to How to register a National Provider Identifier (NPI), or you can go to the HCA Resources page under “Claims billing – encounter data”.
Please read our Core Provider Agreement and NPI Status for Medicaid Services FAQ for more information.
