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Provider Resources & Documents
expand Claims Submission and Reimbursement Policy
HCA Provider Billing Guides and Fee Schedules
SERI Billing Guide July 1, 2018
HCA SERI Guidance June 21, 2019
expand Clinical Practice Guidelines
BH Screening Assessment and Treatment – last updated 10/1/15
Preventive Health Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management
Contacting Disease Management
Disease Management Referral Form
expand Enhanced Personal Health Care Program
Measurement Period Handbook
Program Description for the EPHC
expand EPSDT
EPSDT Reminder Program
EPSDT Toolkit - English
expand HEDIS Training
HEDIS Adult prevention and screening presentation
HEDIS Chronic condition management and CAHPS presentation
expand ICD-10
expand Manuals & QRCs
Medicaid Provider Manual
Medicare Provider Manual
Medicare Provider Dispute, Grievance and Appeal FAQ
expand Maternal Child Program
Maternity Notification Form
Healthy Rewards
New separate reimbursement for long-acting, reversible contraception devices
Provider notification letter regarding long-acting, reversible contraceptive devices with FAQ
Medically Intensive Children's program
New case management program for PTSD resulting from stays in the NICU
Prenatal Ultrasound Policy/ICD-10 Update
expand Medical Management Model
Health Education and Wellness
expand Newsletters - Archived
April 2015 News Bulletin
August 2016 News Bulletin
February 2015 News Bulletin
January 2015 News Bulletin
July 2016 News Bulletin
June 2015 News Bulletin
March 2015 News Bulletin
May 2015 News Bulletin
November 2015 News Bulletin
October 2016 News Bulletin
September 2016 News Bulletin
December 2016 News Bulletin
February 2017 News Bulletin
April 2017 News Bulletin
June 2017 News Bulletin
August 2017 News Bulletin
October 2017 News Bulletin
2017 December Provider Newsletter
April 2018 Provider Newsletter
August 2018 Provider Newsletter
December 2018 Provider Newsletter
expand Newsletters - Current
April 2019 Provider Newsletter
August 2019 Provider Newsletter
December 2019 Provider Newsletter
expand Pharmacy
Medical Injectables Prior Authorization
Pharmacy Benefits Page
Synagis Enrollment Form
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Medicare Quality Improvement Programs
HEDIS Benchmarks and Coding Guidelines
expand Quick Tools
Reimbursement Policies
Requesting preauthorization for the Bariatric Surgery program
Tribal Quick Tips
National drug code: frequently asked questions
Medicare Advantage 2020 Products
Sample Medicare Advantage Member ID Cards
expand Training Programs
Medicare Advantage Asthma Care Training
DSNP Overview Training
My Diverse Patients Training: Creating an LGBT-Friendly Practice
My Diverse Patients
Consumer Assessment of Healthcare Providers and Systems
Ask Me 3 Questionnaire (both Eng and Spn)
Ask Me 3 Flier - Spanish
Improving the Patient Experience CME
2018 Apple Health Medicaid Provider Training
expand Tutorials
Claims Appeals Tutorial
Precertification Request Tutorial
Member Information and Panel Listing
Accessing remittance inquiry process guide
expand Vendor/Partner Links & Information
Washington Health Care Authority (HCA)
AIM (Diagnostic and Imaging Service Authorizations)
PACLAB, LLC (a joint venture with PAML in Western WA)
eyeQuest (Vision Services)
expand Women Infants and Children

Do more online through Provider Self-Service!

  • File and check the status of medical claims
  • NEW — Submit Claims Payment Disputes electronically via Availity
  • Verify eligibility
  • Request precertification via the Interactive Care Reviewer (ICR)
  • Conduct an inquiry on the status of any precertification request via ICR
  • For more information on ICR such as features, support or training go to
  • Submit a Pharmacy Prior Authorization Request
  • And much more!

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Amerigroup Washington, Inc.'s rating increased from 3.0 to 3.5 out of 5 in NCQA's Private Medicaid Health Insurance Plan Ratings 2017-2018.