Medical Billing Services in Washington
Billing, coding, credentialing and denial management for Washington practices, with Medicare claims through Noridian Healthcare Solutions (Jurisdiction JF) and Washington Medicaid handled by people who know the rules.
Medical billing for Washington practices
Washington practices deal with a payer market led by Premera Blue Cross and Regence BlueShield, a large Kaiser Permanente footprint, and Apple Health, the state's Medicaid program. Most Apple Health members are enrolled in one of five managed care plans, while ProviderOne handles enrollment and fee-for-service claims. Medicare Part B claims go to Noridian under Jurisdiction F. The Seattle and Tacoma metro area is dense with specialists, while Eastern Washington and the coastal counties are rural and heavily dependent on Medicare and Apple Health.
SFA Solutions works with Washington practices remotely, from Seattle and Bellevue to Spokane, the Tri-Cities and Yakima. We keep ProviderOne and MCO enrollments aligned, submit most clean claims within 24 hours, and follow up on commercial claims that fall outside the state's 30-day clean claim standard.
Washington at a glance
| Medicare contractor | Noridian Healthcare Solutions, Jurisdiction JF |
|---|---|
| Medicaid timely filing | 365 days from the date of service for the initial claim to HCA (WAC 182-502-0150); managed care plans set limits in their provider contracts |
| NP practice authority | Full |
| Cities we serve | Seattle, Spokane, Tacoma, Vancouver, Bellevue, Kent, Everett, Yakima, Kennewick, Bellingham |
What Washington billing involves
These are the programs and rules our team works with for Washington claims.
Medicare
Noridian Healthcare Solutions · JFWashington Part B claims are processed by Noridian Healthcare Solutions in Jurisdiction JF. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Washington Medicaid
Washington Apple Health (Medicaid), administered by the Washington State Health Care Authority (HCA), including the adult expansion group
Portal: ProviderOne, HCA's Medicaid management information system, for provider enrollment, eligibility and fee-for-service claims
Medicaid managed care
Most Apple Health members are enrolled in an integrated managed care plan: Community Health Plan of Washington, Coordinated Care, Molina Healthcare of Washington, UnitedHealthcare Community Plan or Wellpoint Washington. Coordinated Care also runs Apple Health Core Connections for children in foster care.
Timely filing
365 days from the date of service for the initial claim to HCA (WAC 182-502-0150); managed care plans set limits in their provider contracts.
Commercial and Medicare Advantage
Premera Blue Cross and Regence BlueShield are the largest commercial carriers, with Kaiser Permanente of Washington, UnitedHealthcare, Aetna and Cigna also significant. UnitedHealthcare, Humana and Kaiser Permanente are major Medicare Advantage carriers.
Prompt pay law
Washington's prompt pay rule for health carriers (WAC 284-170-431) requires 95% of the monthly volume of clean claims to be paid within 30 days of receipt and 95% of all claims to be paid or denied within 60 days, with 1% per month interest on clean claims unpaid after 61 days.
Nurse practitioners
Full practiceWashington ARNPs have full practice authority, including prescribing, so they credential and bill under their own NPI without a physician agreement. Medicare pays 85% of the physician fee schedule for services billed under the ARNP's NPI.
Credentialing
Washington law requires health carriers to use a single state-selected credentialing database (RCW 48.43.750), so practices keep one credentialing profile current instead of sending data to each plan separately. Apple Health enrollment is completed in ProviderOne, and each managed care plan then contracts and credentials the provider. Medicaid enrollment must be revalidated at least every five years.
Billing challenges Washington practices face
ProviderOne and MCO alignment
A provider must be enrolled in ProviderOne for Apple Health managed care claims to pay, even when the MCO has credentialed them. Mismatched taxonomy codes or service locations between ProviderOne and the plan are a common source of denials.
Vancouver and Oregon cross-border patients
Practices in Clark County see many Oregon residents with Oregon Health Plan coverage or Oregon commercial plans. These claims follow Oregon rules and need separate enrollment.
Commercial prior authorization
Premera and Regence apply prior authorization to many imaging, specialty drug and procedure codes. Missing authorizations lead to denials that are hard to overturn, so requests need to be filed and tracked before the date of service.
Our services in Washington
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Washington
Washington medical billing questions
What is the timely filing limit for Washington Apple Health?
HCA requires the initial claim to be submitted and assigned a transaction control number within 365 days from the date of service under WAC 182-502-0150. Apple Health managed care plans set their own limits in the provider contract.
Which managed care plans serve Apple Health?
Apple Health managed care plans are Community Health Plan of Washington, Coordinated Care, Molina Healthcare of Washington, UnitedHealthcare Community Plan and Wellpoint Washington. Plan availability varies by region.
How does credentialing work in Washington?
Washington health plans must use one state-selected credentialing database under RCW 48.43.750. Practices keep one profile current there, and plans pull the data. Apple Health also requires ProviderOne enrollment.
Who processes Medicare claims in Washington?
Noridian Healthcare Solutions is the Medicare A/B MAC for Washington under Jurisdiction F. Part B claims, appeals and enrollment changes go through Noridian.
Get a free billing audit for your Washington practice
We will review your recent claims and denials against Washington payer rules and show you what can be recovered.
Nearby states
Primary sources
- WAC 182-502-0150 Time limits for providers to bill the agency
- HCA Apple Health Service Area Matrix (January 2026)
- WAC 284-170-431 Health care provider reimbursement
- RCW 48.43.750 Health care provider credentialing
- CMS: A/B MAC Jurisdiction F (Noridian)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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