Apple Health Behavioral Health Billing in Washington: Plans, Rules and Where BH-ASOs Fit
Apple Health behavioral health billing in Washington runs mostly through managed care plans, and a separate regional organization handles crisis services. Apple Health is Washington’s Medicaid program, run by the Health Care Authority (HCA). Knowing which entity does what keeps claims out of the wrong queue.
What is Apple Health behavioral health billing and managed care?
Apple Health members get covered services through a contracted managed care organization (MCO). HCA’s integrated managed care contract defines Apple Health integrated managed care and treats mental health and substance use disorder services as behavioral health benefits within it (HCA integrated managed care contract, contract period 2020, so verify the current version). For the state’s payer directory, see our Washington State insurance contact guide.
Which Apple Health plans operate in Washington?
HCA’s service area matrix (January 2026) lists five plans: Community Health Plan of Washington, Coordinated Care, Molina Healthcare of Washington, UnitedHealthcare of Washington and Wellpoint Washington (HCA service area matrix).
| Coverage pattern | Counties (examples from the matrix) |
|---|---|
| All five plans | King, Pierce, Snohomish, Thurston, Whatcom, Skagit |
| Four plans (no Wellpoint) | Spokane, Clark, Benton, Chelan, Franklin |
The matrix is the quickest way to see which plans your patients can pick. Apple Health Foster Care is statewide through Coordinated Care. The matrix does not make three counties clear (Kitsap, San Juan, Yakima), so check HCA directly if you practice there. Plan choice by county shapes Apple Health behavioral health billing in Washington.
Who can bill Apple Health for outpatient mental health?
HCA’s mental health billing guide (version effective July 1, 2024) sets the baseline. Mental health professionals must be independently licensed by the Department of Health, be in good standing without restriction, and have a current core provider agreement with HCA and an NPI. For clients age 18 and younger, anyone except a licensed child psychiatrist must submit the Mental Health Professionals Attestation form, HCA 13-951 (HCA mental health services billing guide).
Telemedicine is covered under HCA’s mental health services program. Our telehealth modifiers 93 and 95 guide explains the coding side.
Who pays the claim for an Apple Health therapy session in Washington?
The member’s managed care plan, unless the client is on fee-for-service. The HCA guide says managed care clients must see providers in their MCO’s network unless prior authorized or urgent, and to send claims to the client’s MCO. Providers not contracted with the MCO need approval from both the MCO and the client’s primary care provider before serving a managed care client.
Checklist before you bill:
- Check eligibility for the date of service. See our eligibility glossary and insurance verification page.
- Note whether the client is in an MCO or on fee-for-service.
- Confirm your contract with that MCO.
- Bill the MCO using its referral procedures.
- Keep the attestation on file for clients age 18 and younger.
Billing the MCO, not the BH-ASO, is the key to Apple Health behavioral health billing for outpatient care.
Where do BH-ASOs fit?
A Behavioral Health Administrative Services Organization (BH-ASO) runs crisis services and related programs for a region. HCA’s fact sheet describes crisis and regional programs, not Apple Health claims payment. It says a BH-ASO provides a 24/7 crisis hotline, mobile crisis outreach and other crisis services to anyone in the region regardless of insurance, and may provide non-crisis services to low-income, uninsured or non-Apple Health individuals within available resources (HCA BH-ASO fact sheet).
For a patient in crisis, the BH-ASO is a resource. For routine outpatient claims under Apple Health, follow the MCO path above.
Medicaid rules: what to watch (Apple Health only)
This section covers Apple Health. Commercial plans such as Premera follow different rules; see our upcoming Premera post.
- One evaluation per year. The HCA guide allows one psychiatric diagnostic interview exam (90791) per client, per provider, per calendar year. See our 90791 and 90792 guide.
- Time-based therapy codes. Review psychotherapy codes 90832, 90834 and 90837 for time documentation. Washington’s coverage table lists which provider types may bill which codes, so check the guide’s table for your license.
- Home and community codes. The same HCPCS code can mean different things by state. See the Medicaid HCPCS guide and our Medicaid billing terms glossary. We have no Washington-specific HCPCS page.
Psychiatrists should confirm how each MCO handles E/M visits with psychotherapy add-ons, and ask provider relations rather than assume. For help keeping network status active, read get in-network and stay there. These are the habits that keep Apple Health behavioral health billing clean.
Common Apple Health mistakes
- Billing the state for a client who is enrolled in a managed care plan.
- Seeing a managed care client before the plan and the client’s primary care provider have approved a non-contracted provider.
- Forgetting the attestation form for clients age 18 and younger.
- Using an old billing guide. HCA updates its guides, so confirm the current version.
Review this list whenever your Apple Health behavioral health billing process changes.
Frequently asked questions
Is Apple Health the same as Washington Medicaid?
Yes. Apple Health is Washington’s Medicaid program, administered by HCA.
Do I bill the BH-ASO for outpatient therapy?
Not for Apple Health managed care. HCA’s guide says to send claims to the client’s MCO, while BH-ASOs focus on crisis services and regional programs.
What do I need to bill Apple Health directly?
Independent DOH licensure in good standing, a current core provider agreement with HCA and an NPI, per HCA’s guide.
How many Apple Health plans are there?
Five, per HCA’s January 2026 service area matrix. Which ones serve a patient depends on the county.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices, including psychotherapists and psychiatrists, and bills out-of-network claims. We offer our services to practices in Washington State, and we also work with practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If you want to talk through your own billing, you can request a free consultation.
If you practice in Washington State, you can request a free consultation. Our mental health billing FAQ answers more common questions.
