WAC 296-20-12401
Provider application process. (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.