Apple Health Billing Guide Updates, Effective 1/1/19

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Apple Health (Medicaid) Provider Alert

Quarterly billing guide updates, January 1, 2019
Effective January 1, 2019, the Health Care Authority (HCA) is publishing quarterly updates to most of the Washington Apple Health billing guides. Billing guides are located on HCA’s Provider billing guides and fee schedule web page. Check the web page often. HCA is loading the revised billing guides as soon as they are finalized for publishing.

Apple Health – Changes for January 1, 2019
Effective January 1, 2019,
managed care organizations (MCOs) that are contracted with Apple Health in certain Regional Service Areas (RSAs) will expand their coverage of behavioral health services (mental health and substance use disorder treatment), along with continuing to cover physical health services.

Apple Health clients who are not enrolled in a contracted MCO for their physical health services (e.g., dual-eligible Medicare-Medicaid clients) will still receive their behavioral health services through one of the contracted MCOs. The MCO will provide only behavioral health services for the client.

Most clients will remain with the same health plan, except in regions where client’s plan will no longer be available. HCA will auto-enroll these clients to one of the offered plans.

To view a map and table of the integrated Apple Health managed care plans available within each region, please see Changes coming to Washington Apple Health. You may also refer to the HCA’s Apple Health managed care webpage.