Medical billing services in Washington
Washington practices deal with Apple Health managed care, a concentrated commercial market and some of the tightest clean claim expectations in the country. We work your claims to payment instead of leaving them to age.
- WABilled end to end
- 7+Plans commonly billed
- 50+Specialties covered
What actually goes wrong with Washington claims
These are important areas to check when configuring a Washington billing workflow. The applicable plan and date of service determine the requirements.
- A concentrated commercial market
Premera and Regence carry a large share of commercial lives here, so a single policy change from one carrier can move a practice’s entire denial rate in a month.
- Apple Health plan variation
Five managed care plans, five sets of authorization and corrected claim rules. We bill to the plan the patient is actually enrolled in, verified before the visit.
- Integrated behavioral health billing
Washington pushed behavioral health integration further than most states. That creates real coding questions about what is billable alongside a medical visit, and that is where the denials come from.
Apple Health billing
Washington Apple Health, administered by the Health Care Authority.
Most Apple Health members are enrolled in a managed care plan such as Molina, Coordinated Care, Community Health Plan of Washington or Wellpoint. The plan controls authorization and appeals, and each one handles corrected claims differently.
Plans a Washington practice bills
These are plans operating in Washington. Your account is configured for the ones you actually see, not a statewide average. If yours is not listed, ask.
Before a Washington claim is submitted
Configure the work around Apple Health and the plans your practice actually sees.
- Confirm the member plan and billing destination for each date of service.
- Check provider enrollment, service location and authorization requirements.
- Use the applicable filing and appeal deadlines in the claim worklist.
- Reconcile payments against the relevant contract or fee schedule.
Serving practices across Washington
We work remotely inside your practice management system, so where you sit inside the state does not change what we can do. These are simply where Washington practices most often are.
Washington billing questions
Do you work Apple Health managed care claims?
Yes, through whichever plan the patient is enrolled in. We verify the plan before the visit rather than after the denial.
Our denials spiked after a Premera policy change. Can you find the cause?
That is exactly what the ninety day claims review is for. We look for the pattern, identify the specific policy or edit causing it, and feed the fix back into coding so it stops repeating.
Do you bill behavioral health alongside primary care?
Yes. Integrated behavioral health is one of the more common sources of preventable denials in Washington, and it is a coding problem before it is a billing problem.
Can you work with our existing Seattle based staff?
Yes. Most of our clients keep their front desk and we take the coding, claims, denials and A/R. Nobody has to be replaced for this to work.
Find out what Washington payers owe you
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.