The Washington Provider Payment Account Change Form is an official document used by providers in the state of Washington to change the payment account that is associated with their medical provider services. This form is used to update the banking information for payments made by the Washington State Health Care Authority (HCA) to the provider. There are two types of Washington Provider Payment Account Change Forms: one for Providers and one for Billing Agents. The Provider form is used when the provider wants to change the bank account or routing number to which their payments are deposited. The Billing Agent form is used when a billing agent submits claims on behalf of a provider and wants to change the bank account or routing number to which their payments are deposited. Both forms require the provider to provide the HCA with their new banking information and must be signed and dated by the provider or their authorized representative.
Washington Provider Payment Account Change Form
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How to fill out Washington Provider Payment Account Change Form?
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FAQ
Apple Health is the name for Medicaid in Washington.
Medical Bills must be filed within 12 months of the date of service for all services rendered in Washington.
Please use CHPW's Payer Identifier: CHPWA.
Go to .Lni.wa.gov/Verify, select the option that applies to you, and search by name. To change your address online, just put in your information and make selections ingly. Update your mailing address, phone number, and email address. Repeat for each of your licenses and certificates.
Select ClaimRemedi, Billing Agent/Clearinghouse ProviderOne ID: 2010950.
ProviderOne is the computer system that coordinates with the health plans. It also sends you letters and handbooks. The number on the card is your ProviderOne client number.
Submit Claims to Molina through your EDI clearinghouse using Payer ID 38336, refer to our website .molinahealthcare.com/providers/common/medicaid/ediera/edi/benefits.aspx for additional information.