Jan
06
2025
Discovery log number
00436
Discovery description
We have become aware of a Remittance Advice reconciliation issue that occurred during last week’s payment and remittance cycle on January 1-3, 2025. To be clear, this is a remittance issue, not a payment issue. While we are still diagnosing the root cause and remediation, we want to provide assurance that payments made last week on January 3, were accurate. Impacted providers received a Remittance Advice showing a lower payment amount than the actual payment amount received by the providers. Once remediation activities have been defined, specific outreach will be conducted with impacted providers.
Please submit additional questions to MMISHelp@hca.wa.gov
Date reported
ETA
Provider impact
All Providers
Workaround
Please submit additional questions to MMISHelp@hca.wa.gov
Connect Program
The Health Care Authority (HCA) is participating in a statewide electronic health record (EHR) implementation to enhance health care services for providers and patients. Learn about the background of the Connect Program and next steps.
On this page
Purpose
Washington’s Apple Health (Medicaid) population of nearly 2 million members frequently use services provided by HCA, the Department of Social and Health Services (DSHS), and the Department of Corrections (DOC). HCA will use the Epic platform with shared governance and resources to support this population. This will improve health care coordination between providers and allow the state to provide high-quality care more effectively for Apple Health clients being served by community providers.
The Connect Program will allow improvements in areas such as:
- Infant case management.
- Maternity support services.
- Long-term care and support services.
- Behavioral health.
- Tribal health.
- Prior authorization.
- Utilization management.
- And more.
Model and functionality
Contracted providers will have access to the Epic EHR platform via HCA’s Connect Program. This model allows smaller health care organizations to access the full capabilities of the Epic EHR system.
This model enables several benefits, including:
- Improved patient care through streamlined workflows.
- Enhanced data access.
- Strong interoperability with other health care systems.
- Robust reporting and analytics capabilities.
- Highly customizable solutions.
- Patient engagement features through a patient portal.
- Reduced administrative tasks by facilitating seamless data exchange between different. departments within a health care organization.
Interoperability functions will allow data to be shared between providers using similar and dissimilar systems. The extent of data sharing capabilities will vary from system to system.
A wraparound service vendor will be selected to engage, onboard, and support HCA contracted providers who use the system.
HCA intends to implement with identified providers in cohorts. The initial cohort will be focused on Indian health care providers, behavioral health and substance use disorder (SUD) providers, long-term care, and crisis responders. Additional cohorts will include rural hospitals, jails, and more. Providers will be prioritized based on Apple Health clients supported.
Next steps
The Connect Program expects to kick off the implementation phase in Q1 2026. HCA providers would go live with the system Q1 2027. Next steps include:
- Continue to work with Epic to finalize contract to procure statewide EHR.
- Finalize the RFP for system integrator and lead organization services. The chosen vendors will work closely with the Health Care Management and Coordination System (HCMACS) Program and Epic to deliver project and consulting resources, oversight, and guidance.
- HCA will engage with Indian health care providers and behavioral health providers to assess needs, identify requirements, outline readiness activities, and finalize contracts.
2025
The State Plan is the officially recognized statement describing the nature and scope of Washington State's Medicaid program.
| Title | SPA packet number | Date approved |
|---|---|---|
| January 2025 Fee Schedule Updates | 25-0007 | 04/23/2025 |
Provider Alerts 2025
Emails relevant to rules, Medicaid provider guides, and policies.
| Date | Provider Alert |
|---|---|
| 01/09/2025 | MES and CRT – removal of prior authorization for certain HCPCS codes |
| 01/21/2025 | Applied Behavior Analysis (ABA) billing guide updates – Effective February 1, 2025 |
| 01/29/2025 | Home Health providers – Electronic Visit Verification (EVV) update |
| 02/19/2025 | Kidney Center Services Billing Guide, Effective 02/19/2025 |
| 02/28/2025 | Birth doula billing guide updates eff. February 28, 2025 |
| 02/28/2025 | Physicians billing guide updates |