Instructions and frequently asked questions
- Network Access Reports submission instructions (PDF 549.90KB)
- Urban Counties (updated 03-30-2022) (XLSX 15.48KB)
- Frequently Asked Questions (updated 3-30-23) (PDF 514.73KB)
Templates
- Access Plan cover sheet (PDF 106.08KB)
- Alternative Access Delivery Request (AADR) – Request Form (PDF 15.83KB)
- Form C - AADR (Alternative Access Delivery Request Form C) (Updated 3-30-23) (PDF 388.61KB)
- Network Enrollment Form B Report (updated 12-1-2020) (XLSX 272.31KB)
- Provider Network Form A - AADR (XLSX 16.69KB)
Provider network form A
Note: The Provider Network Form A's National Plan and Provider Enumeration System (NPPES) data was loaded on 6/26/2025 using the NPPES file from 6/09/2025.
- Provider Network Form A instructions (updated 3-27-2025) (PDF 647.25KB)
- Provider Network Form A FAQ (updated 5-12-22) (PDF 306.62KB)
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 and WAC 284-170-280(3)(c) for more information.
The first report for calendar year 2025 is due Jan. 5, 2025. After that, reports are due monthly by the 5th of each month (i.e. Feb. 5, 2025).
Amended alternate access delivery request form E
An issuer that meets the criteria in RCW 48.49.135(2)(b) may submit an amended alternate access delivery request (AADR) for review and approval. The issuer must submit a request to open the filing portal following the instructions on the form. The submission must include the: Amended Alternate Access Delivery Request Form E, Amended AADR Contact Log form, and supporting documentation.
- Request to Open Portal (PDF 1.19MB)
- Amended Alternate Access Delivery Request Form E (PDF 1.08MB)
- Amended Alternate Access Delivery Request Contact Log (PDF 107.28KB)
Analyst checklists
- Network Access Reports (updated 3-30-23) (DOCX 75.67KB)
- Analyst Checklist Provider and Facility Agreements (updated 7/1/2024) (DOCX 73.00KB)
- Analyst Checklist Single Case Provider and Facility Agreements (updated 7/1/2024) (DOCX 67.10KB)