Draft Guide (60-day Preview)
Use for claims billed on and after ProviderOne Go Live.

Individual Sections

• Introduction

• Medical Assistance Overview

• Client Eligibility, Benefit Packages, and Coverage Limits

• Submit Fee-for-Service Claims to Medical Assistance

• The DSHS Remittance Advice

To view and download the following DSHS forms
which are discussed in this General Information Booklet,
click on the following link:
http://www1.dshs.wa.gov/msa/forms/eforms.html

• Expedited Prior Authorization Forms
• Adjustment Request Form [DSHS 13-715]
• Electronic Funds Transfer (EFT) [DSHS 18-633]
• Corrected Claim [DSHS 13-741]

Third Party Insurance Carrier Codes
 

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