Notice of Application Fee

Provider Alert

What is changing?

Effective June 1, 2016, Washington Apple Health (Medicaid) is implementing an application fee for institutional provider enrollment applications. Providers currently enrolled with Apple Health will not be affected.

Why is the Health Care Authority (HCA) requiring an application fee?

HCA is required to collect this fee under 42 CFR § 455.460. The fee is $554, and is set annually by the Center for Medicare & Medicaid Services (CMS). HCA expects a small volume (less than 10 per month) of enrolling providers will be subject to the fee. These providers will be notified by mail when the application requires a fee.  

Which provider types are subject to the application fee? 

Certain provider types who submit applications for initial enrollment will be subject to the provider enrollment application fee. See the attached “Application Fee Matrix” for a detailed list of the provider types subject to the application fee and the provider types exempt from the fee.

Which providers are exempt from the application fee?

Providers who meet one of the following criteria are not subject to the application fee:

• Individual physicians and non-physician practitioners or groups of physicians and groups of non-physician practitioners
• Currently enrolled with Medicare or another state’s Medicaid program 

For additional information about federal and state regulations related to the provider enrollment application fee, see 42 CFR 455, Subpart E, 42 CFR 455.460 and WAC 182-502-0010 (k).

Email questions about the HCA provider enrollment application fee process to providerenrollment@hca.wa.gov, or contact 1-800-562-3022 extension 16137.

The agency will update the ProviderOne Billing and Resource Guide with this new requirement by June 1^st.

Thank you.