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EXPANSION  \nMANAGED CARE  \nJULY 2026  \nTABLE OF CONTENTS  \n01 INTRODUCTION ...............................................................................................................9  \n1.1 Welcome...........................................................................................................................9  \n1.2 About Coordinated Care ...................................................................................................9  \n1.3 Our Mission ......................................................................................................................9  \n1.4 How to Use This Provider Manual ....................................................................................9  \n1.5 Key Contacts and Important Phone Numbers ................................................................10  \n1.6 Coordinated Care Website ............................................................................................. 12  \n1.7 Secure Provider Portal.................................................................................................... 13  \n1.8 Coordinated Care Community Educators ....................................................................... 14  \n1.9 Washington Apple Health (Medicaid) Program Summary............................................... 14  \n02 APPLE HEALTH EXPANSION ........................................................................................ 15  \n03 CREDENTIALING and RE-CREDENTIALING ................................................................16  \n3.1 Washington Apple Health (Medicaid) Core Provider Agreement ....................................18  \n3.2 Credentialing Committee ................................................................................................ 18  \n3.3 Re-credentialing ............................................................................................................. 18  \n3.4 Provider Right to Review and Correct Information ..........................................................19  \n3.5 Provider Right to Be Informed of Application Status .......................................................19  \n3.6 Provider Right to Appeal Adverse Credentialing Determinations....................................20  \n04 PRIMARY CARE PROVIDER RESPONSIBILITIES ........................................................20  \n4.1 Role of Primary Care Providers (PCP) ...........................................................................20  \n4.2 Primary Care Provider (PCP) Responsibilities ................................................................21  \n4.3 Provider Types That May Serve As PCPs ......................................................................23  \n4.4 Member Panel Capacity .................................................................................................23  \n4.5 Member Selection or Assignment of PCP.......................................................................24  \n4.6 PCP Referrals to Specialists...........................................................................................25  \n4.7 Member Self-Referral Options ........................................................................................25  \n4.8 Specialists as PCPs........................................................................................................26  \n4.9 Specialist Provider Responsibilities ................................................................................27  \n4.10 Appointment Availability and Wait Times ......................................................................27  \n4.11 Travel Distance and Access Standards ........................................................................29  \n4.12 Covering Providers .......................................................................................................31  \n4.13 Provider Phone Call Protocol...............................","cbCaitHLSzCOVWHG","https://ap.wps.com/l/cbCaitHLSzCOVWHG","pdf",3188571,171,"English","# 01 INTRODUCTION\n## Welcome\n## About Coordinated Care\n## Our Mission\n## How to Use This Provider Manual\n## Key Contacts and Important Phone Numbers\n## Coordinated Care Website\n## Secure Provider Portal\n## Coordinated Care Community Educators\n## Washington Apple Health (Medicaid) Program Summary\n# 02 APPLE HEALTH EXPANSION\n# 03 CREDENTIALING and RE-CREDENTIALING\n## Washington Apple Health (Medicaid) Core Provider Agreement\n## Credentialing Committee\n## Re-credentialing\n## Provider Right to Review and Correct Information\n## Provider Right to Be Informed of Application Status\n## Provider Right to Appeal Adverse Credentialing Determinations\n# 04 PRIMARY CARE PROVIDER RESPONSIBILITIES\n## Role of Primary Care Providers (PCP)\n## Primary Care Provider (PCP) Responsibilities\n## Provider Types That May Serve As PCPs\n## Member Panel Capacity\n## Member Selection or Assignment of PCP\n## PCP Referrals to Specialists\n## Member Self-Referral Options\n## Specialists as PCPs\n## Specialist Provider Responsibilities\n## Appointment Availability and Wait Times\n## Travel Distance and Access Standards\n## Covering Providers\n## Provider Phone Call Protocol\n## 24-Hour Access to Providers\n## Hospital Responsibilities\n## Provider Network Development and Maintenance\n## Behavioral Health Network\n## The Network Provider’s Office\n## General Network Practitioner Office Standards\n## Network Provider Concerns\n## Network Provider Standards of Practice\n## Referrals to Specialists\n## Hospital and Tertiary Care\n## Marketing Requirements\n## Advance Directives/POLST\n## Member Self-Determination\n## Interpreter Services\n## Provider Network Termination","[{\"question\":\"What is the purpose of the Provider Operations Manual for Washington Apple Health managed care?\",\"answer\":\"It provides guidance for provider operations within Washington Apple Health (Medicaid) Foster Care and Apple Health Expansion Managed Care, including how providers should use the manual and understand coordinated care expectations.\"},{\"question\":\"What credentialing and re-credentialing topics are covered?\",\"answer\":\"The manual covers the Washington Apple Health (Medicaid) Core Provider Agreement, the credentialing committee process, re-credentialing, and provider rights to review/correct information, be informed of application status, and appeal adverse determinations.\"},{\"question\":\"What primary care provider responsibilities are emphasized?\",\"answer\":\"It details PCP roles and responsibilities, referral processes, member panel and assignment concepts, appointment availability and wait times, travel distance/access standards, coverage expectations, and network maintenance including behavioral health, interpreter services, and advance directives requirements.\"}]","PROVIDER OPERATIONS MANUAL - Washington Apple Health 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