Network access

Find network access filing requirements, forms and instructions.

Instructions and frequently asked questions

• Network Access Report Submission instructions (updated 5-12-22) (PDF, 467.24 KB)
• Urban Counties (updated 4-04-2022) (Excel, 15.45 KB)
• Frequently Asked Questions (updated 5-12-22) (PDF, 243.41 KB)

Templates

• Access Plan cover sheet (Word, 21.36 KB)
• ​Alternative Access Delivery Request (AADR) – Request Form (PDF, 15.83 KB)
• Form C - AADR (Alternative Access Delivery Request Form C) (updated 4-9-18) (PDF, 168.83 KB)
• Network Enrollment Form B Report (updated 12-1-2020) (Excel, 272.31 KB)
• Provider Network Form A - AADR (Excel, 16.69 KB)

Provider Network Form A

Note: The Provider Network Form A's National Plan and Provider Enumeration System (NPPES) data was loaded on 3/18/2022 using the NPPES file from 3/15/2022.

• ​ Provider Network Form A instructions (updated 3-31-2020) (PDF, 676.25 KB)
• ​ Provider Network Form A FAQ (updated 5-12-22) (PDF, 306.62 KB)

988 Crisis Hotline Appointment Form D

You must file the 988 Crisis Hotline Appointment D report if you're a disability insurer, health care service contractor (HCSC) or health maintenance organization (HMO) that will be issuing or renewing a health plan after Jan. 1, 2023. Please see RCW 48.43.790 (leg.wa.gov) and WAC 284-170-280(3)(c) (leg.wa.gov) for more information. 

The first report for calendar year 2023 is due Jan. 7, 2023. After that, reports are due monthly by the 5th of each month (i.e. Feb. 5, 2022).

• 988 Crisis Hotline Appointment Form D report (Excel, 47.84 KB)

Analyst checklists

• Network Access Reports (updated 3-4-19) (PDF, 1.01 MB)
• Provider and Facility Agreements (updated 3-28-22) (Word, 65.47 KB)
• Single Case Provider and Facility Agreements (updated 3-28-22) (Word, 59.57 KB)

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• Network Access Portal