Wash. HCA Hospice Services Billing Guide, How do I verify a client’s eligibility?

Most Apple Health clients are enrolled in an HCA-contracted managed care

organization (MCO). This means that Apple Health pays a monthly premium to an

MCO for providing preventative, primary, specialty, and other health services to

Apple Health clients. Clients in managed care must see only providers who are in

their MCO’s provider network, unless prior authorized or to treat urgent or

emergent care. See HCA’s Apple Health managed care page for further details.

It is important to always check a client’s eligibility prior to

providing any services because it affects who will pay for the

services.

Check the client’s Services Card or follow the two-step process below to verify

that a client has Apple Health coverage for the date of service and that the

client’s benefit package covers the applicable service. This helps prevent

delivering a service HCA will not pay for.

Verifying eligibility is a two-step process:

Step 1. Verify the patient’s eligibility for Apple Health. For detailed

instructions on verifying a patient’s eligibility for Apple Health,

see the Client Eligibility, Benefit Packages, and Coverage Limits

section in HCA’s ProviderOne Billing and Resource Guide.

If the patient is eligible for Apple Health, proceed to Step 2. If

the patient is not eligible, see the note box below.

Step 2. Verify service coverage under the Apple Health client’s

benefit package. To determine if the requested service is a

covered benefit under the Apple Health client’s benefit package,

see HCA’s Program Benefit Packages and Scope of Services

webpage.

Note: Patients who are not Apple Health clients may apply for

health care coverage in one of the following ways:

• Online: Go to Washington Healthplanfinder - select

the "Let’s get started" button. For patients age 65 and older,

or on Medicare, go to Washington Connections – select the

“Apply Now” button.

• Mobile app: Download the WAPlanfinder app – select

“sign in” or “create an account”.

• Phone: Call the Washington Healthplanfinder Customer

Support Center at 1-855-923-4633 or 855-627-9604 (TTY).

• Paper: By completing an Application for Health Care

Coverage (HCA 18-001P) form. To download an HCA form,

see HCA’s Free or Low Cost Health Care, Forms &

Publications webpage. Type only the form number into the

Search box (Example: 18-001P). For patients age 65 and

older, or on Medicare, complete the Washington Apple

Health Application for Age, Blind, Disabled/Long-Term

Services and Supports (HCA 18-005) form.

• In-person: Local resources who, at no additional cost, can

help you apply for health coverage. See the Health Benefit

Exchange Navigator.