Medical Billing Services in Washington
Washington’s Medicaid program covers most members through managed care, but which plan a patient carries depends on where they live. Five plans deliver Apple Health across the state, and availability varies by county, so a practice with patients in two counties can easily be billing two different plan rulebooks in the same week. Add a commercial market led by two Blues carriers and an integrated delivery system, and Washington rewards billing teams that verify plan and county before every visit.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Washington practices of every specialty, built around the state’s actual payers and programs.
Washington’s payer landscape
Washington Medicaid is called Apple Health, delivered through five managed care organizations: Coordinated Care, Community Health Plan of Washington, Molina Healthcare of Washington, UnitedHealthcare Community Plan, and Wellpoint Washington (formerly Amerigroup). All five plans cover the same core Medicaid benefits set by the state, but provider networks and extra benefits differ, and plan availability varies by county of residence. A smaller group of members receives Apple Health fee-for-service, including members who opt out of managed care under federal rules.
Commercial coverage is led by Premera Blue Cross and Regence BlueShield, alongside Kaiser Foundation Health Plan of Washington, UnitedHealthcare, and Aetna. Medicare and Medicare Advantage plans add their own prior authorization rules on top of the Apple Health and commercial mix.
What MedPlus RCM handles for Washington practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Apple Health plans, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Seattle, Spokane, Tacoma, Vancouver, Bellevue, and Everett, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Washington practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
Do all Apple Health plans cover the same benefits?
The core medical benefits are set by the state and are the same across all five plans. Networks and extra benefits differ, and plan availability varies by county.
Do you work with Apple Health plans?
Yes. We bill Coordinated Care, Community Health Plan of Washington, Molina Healthcare of Washington, UnitedHealthcare Community Plan, and Wellpoint Washington, as well as commercial and Medicare plans.
Can patients switch Apple Health plans?
Yes. Apple Health members may change plans, so plan assignment should be verified at each visit rather than assumed from a prior encounter.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Washington practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
