Core Provider Agreement and NPI Status - Washington State Local Health Insurance - CHPW

Core Provider Agreement and NPI Status

An update from the Washington State Health Care Authority (HCA) will impact claims payment if you have not already taken action.

CHPW follows the Apple Health fee-for-service guidance. This means that in order for your encounters and claims to be accepted your National Provider Identifier (NPI) must be actively enrolled with the HCA on or before January 1, 2022; or you must have an approved application on file with the state, dated on or before the date you begin seeing CHPW members. If you do not bill with a registered NPI, CHPW will begin denying claims and, if necessary, we will recoup paid claims.

Did you previously receive a notice from CHPW or another Managed Care Organization (MCO) that:

  • You have an NPI that is not active?
  • You are not enrolled in ProviderOne (Washington State’s Medicaid billing and payment system)?

If yes, then you must register in ProviderOne by June 30, 2022 or risk potential claim recoupment. Go to https://www.hca.wa.gov/billers-providers-partners/providerone/providerone-user-manuals#enrolling-as-a-provider to register.

The HCA is experiencing a high volume of applications. Providers who have successfully applied receive the following message that includes a 14-digit application number:

Core Provider Agreement

If you have received this message, rest assured that your application is being processed and only contact HCA if you receive a notification about their application from the agency.

Please do not call HCA to confirm receipt of your application, unless you did not receive the above message when you submitted your application.

Please read our Core Provider Agreement and NPI Status for Medicaid Services FAQ for more information.

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