Is the Core Provider Agreement required for fee for service and Healthy Option providers?
The Core Provider Agreement is required for providers who see fee for service Medical Assistance clients with respect to services included in the scope of the client’s Medical Assistance program.The Core Provider Agreement is not required for providers who see clients enrolled in Healthy Option. However, the provider should have an agreement with the client’s Healthy Option plan(s). If the provider chooses to treat the Healthy Option client without such an agreement, but has a Core Provider Agreement, the provider is bound by the Core Provider Agreement to seek reimbursement from the plan for services included in the plan’s contract with the department. See WAC 388-502-0100(6); WAC 388-538-070(3).If the provider does not have a Core Provider Agreement or a contract with a HO plan, the provider should not be seeing the client. However, an individual, whether receiving medical assistance or not, has the right to obtain medical services from providers that do not accept the patients insur
