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.
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.
[Statutory Authority: RCW 51.36.010
, 51.04.020, and 51.04.030. WSR 12-06-066, § 296-20-12401, filed 3/6/12, effective 4/6/12. Statutory Authority: RCW 51.04.020
, 51.04.030, 51.36.080. WSR 00-09-078, § 296-20-12401, filed 4/18/00, effective 7/1/00.]