Network access

Find network access filing requirements, forms and instructions.

Instructions and frequently asked questions

• Network Access Report Submission instructions (updated 3-30-23) (Word, 344.29 KB)
• Urban Counties (updated 03-30-2022) (Excel, 15.64 KB)
• Frequently Asked Questions (updated 3-30-23) (PDF, 324.21 KB)

Templates

• Access Plan cover sheet (Word, 42.69 KB)
• ​ Alternative Access Delivery Request (AADR) – Request Form (PDF, 15.83 KB)
• Form C - AADR (Alternative Access Delivery Request Form C) (Updated 3-30-23) (PDF, 388.61 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 05/15/2023 using the NPPES file from 05/08/2023.

• ​ Provider Network Form A instructions (updated 11-2-2022) (Word, 163.85 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 Form D report (Excel, 47.84 KB)

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, 1.19 MB)
• Amended Alternate Access Delivery Request Form E (PDF, 1.08 MB)
• Amended Alternate Access Delivery Request Contact Log (PDF, 107.28 KB)

Analyst checklists

• Network Access Reports (updated 3-30-23) (Word, 75.01 KB)
• 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