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Network access

Find network access filing requirements, forms and instructions.

Instructions and frequently asked questions

Templates

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.

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).

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