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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 296. Labor and Industries, Department of |
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Chapter 296-20. Medical aid rules. |
Section 296-20-12401. Application process for providers outside the scope of the provider network.
Latest version.
- For providers or services not subject to the health care provider network requirements, including treatment at the initial office or emergency room visit, a provider must obtain a provider account number from the department.(1) How can a provider obtain a provider account number from the department? In order to receive a provider account number from the department, a provider must:• Complete a provider application;• Sign a provider agreement;• Provide a copy of any practice or other license held;• Complete, sign and return a Form W-9; and• Meet the department's provider eligibility requirements as cited in the department's rules.Notes:A provider account number is required to receive payment from the department, but is not a guarantee of payment for services.Self-insured employers may have additional requirements for provider status.(2) Provider account status definitions.• Active - Account information is current and provider is eligible to receive payment.• Inactive - Account is not eligible to receive payment based on action by the department or at provider request. These accounts can be reactivated.• Terminated - Account is not eligible to receive payment based on action by the department or at provider request. These accounts can not be reactivated.(3) When may the department inactivate a provider account? The department may inactivate a provider account when:• There has been no billing activity on the account for eighteen months; or• The provider requests inactivation; or• Provider communications are returned due to address changes; or• The department changes the provider application or application procedures; or• Provider does not comply with department request to update information.(4) When may the department terminate a provider account? The department may terminate a provider account when:• The provider is found ineligible to treat per department rules; or• The provider requests termination; or• The provider dies or is no longer in active business status.(5) How can a provider reactivate a provider account? To reactivate a provider account, the provider may call or write the department. The department may require the provider to update the provider application and/or agreement or complete other needed forms prior to reactivation. Account reactivation is subject to department review.If a provider account has been terminated, a new provider application will be required.