MedStats Billing delivers end-to-end revenue cycle management built for Washington practices. We hold carriers to the per-provider 95% clean claim standard in WAC 284-170-431, bill Apple Health Integrated Managed Care across every plan and regional service area, and manage L&I workers’ compensation from Medical Provider Network enrollment through MARFS pricing across the Evergreen State.
Washington gives providers a prompt pay standard stronger than most states realise, and a workers’ compensation system that will not pay a provider who skipped one enrollment step. The Health Care Authority delivers Apple Health through integrated managed care plans that cover physical and behavioural health together, while crisis and non-Medicaid behavioural health run through separate regional administrative organisations. On the injury side, Labor & Industries operates a monopoly state fund with its own network, its own fee schedule and its own billing route.
Washington Billing Specializations:
The Per-Provider 95% Standard (WAC 284-170-431) — Carriers must pay 95% of the monthly volume of clean claims within 30 days and pay or deny 95% of all claims within 60 days. The Insurance Commissioner has confirmed that volume is measured against each individual provider’s claims, not the carrier’s entire book. We measure your practice’s own compliance rate and use it.
Apple Health Integrated Managed Care — Physical and behavioural health are delivered together by Wellpoint, Community Health Plan of Washington, Coordinated Care, Molina Healthcare of Washington and UnitedHealthcare Community Plan, each with its own edits by regional service area.
BH-ASO Crisis Services — Behavioural Health Administrative Services Organizations handle crisis response and non-Medicaid behavioural health separately from the integrated plan. Claims sent to the wrong entity are denied on routing alone.
L&I Medical Provider Network — Providers practising in Washington must belong to the L&I network to be paid for treating an injured worker beyond the initial office or emergency room visit. We confirm network status before care continues, not after the denial arrives.
MARFS Pricing and the Balance-Billing Bar — Bills priced to the Medical Aid Rules and Fee Schedules, which use L&I’s own billing codes alongside standard HCPCS. Under RCW 51.36.100 and 51.36.110 a provider may not bill the worker for the difference between the allowable fee and the usual charge.
Major Washington Payers — Premera Blue Cross, Regence BlueShield, Kaiser Permanente Washington, Community Health Plan of Washington, UnitedHealthcare and Molina denial workflows.
Built to bring clarity, control and consistency to your Washington practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Washington providers — from ProviderOne enrollment and L&I network credentialing, through Apple Health and commercial claim submission, to prompt-pay enforcement and recovery of aged receivables.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceWashington practices lose revenue to enrollment gaps and to a payment standard they never measure. These are the four we eliminate:
Providers practising in Washington must be in the L&I Medical Provider Network to be paid for care beyond the first office or emergency room visit. Treatment delivered outside it is unbillable no matter how well documented, and the requirement applies to self-insured employers too.
Carriers owe 95% clean claim payment within 30 days measured against your practice's own monthly volume. Practices that never calculate their own rate have no way to show a carrier is out of compliance, so the standard is never enforced and interest is never claimed.
Providers enroll and credential with L&I through ProviderOne, but L&I does not use ProviderOne for billing. Practices that assume one system handles both send bills into a channel that will never pay them.
Behavioural health crisis and non-Medicaid services run through a regional BH-ASO while everything else sits with the integrated managed care plan. Sending either to the other produces a denial that has nothing to do with medical necessity.
Carriers must pay 95% of the monthly volume of clean claims within 30 days of receipt, and pay or deny 95% of all claims within 60 days. Coordination of benefits rules add that a secondary plan taking more than 30 days after receiving the primary's explanation of benefits is unreasonable.
The Insurance Commissioner has advised that the monthly volume in the rule means each provider's claims to that carrier, not the carrier's total from all providers. Carriers owe your practice the standard individually, and interest is assessed on claims not timely paid.
Physical and behavioural health are integrated in one plan, while crisis and non-Medicaid behavioural health route to a regional BH-ASO. Providers must contract with the client's plan, and enrollment can change monthly, so we verify in ProviderOne before each visit.
Washington runs a monopoly state fund alongside self-insured employers. Network membership is required for continued care, bills are priced to MARFS using L&I's own codes, and under RCW 51.36.100 the worker cannot be balance-billed for the difference.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles ProviderOne enrollment, L&I network credentialing, Apple Health and commercial claim processing, prompt-pay enforcement and denial resolution across Washington, giving practices end-to-end RCM support in a state where one missed enrollment step makes good care unbillable.
Claims are scrubbed against integrated managed care plan and commercial payer edits before submission to drive clean first-pass reimbursement.
Rejected claims are audited immediately, appealed with complete clinical documentation, and tracked until they are paid.
Alongside collections and AR aging, we report each carrier’s clean claim performance against your own monthly volume, so the 95% standard becomes a number you can act on.
Working knowledge of Premera Blue Cross, Regence BlueShield, Kaiser Permanente Washington, Community Health Plan of Washington, Molina and Coordinated Care submission protocols.
Whether you practise in Seattle, Spokane, Tacoma or Vancouver, our workflows adjust seamlessly as your group grows across regional service areas.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, measure how each carrier performs against the 95% clean claim standard on your own volume, and confirm your L&I network and ProviderOne enrollments are current.
Under WAC 284-170-431 a carrier must pay 95% of the monthly volume of clean claims within 30 days of receipt, and pay or deny 95% of the monthly volume of all claims within 60 days. Interest is assessed on claims that are not paid on time.
Per practice. The Office of the Insurance Commissioner has advised that the monthly volume in the rule refers to each provider’s claims submitted to that carrier, not the carrier’s total claims from all providers. That means a carrier owes your practice the standard on your own claim volume.
The Health Care Authority contracts with Wellpoint, Community Health Plan of Washington, Coordinated Care of Washington, Molina Healthcare of Washington and UnitedHealthcare Community Plan. Providers must contract with the client’s specific plan, and enrollment can change monthly, so eligibility should be verified in ProviderOne before each visit.
Yes. Providers practising in Washington must belong to the L&I Medical Provider Network to be paid for treating an injured worker beyond the initial office or emergency room visit. The requirement applies to workers of businesses covered by the L&I State Fund and to those employed by self-insured employers.
No, and this catches practices out regularly. Providers apply for an L&I account and complete credentialing through ProviderOne, but L&I does not use ProviderOne to receive medical bills. Bills go through L&I’s own billing channels, priced to the Medical Aid Rules and Fee Schedules.
No. Under RCW 51.36.100 and RCW 51.36.110 a provider may not bill the worker for the difference between the allowable fee under the fee schedule and the usual and customary charge. All services on workers’ compensation claims are also subject to audit by L&I.
We serve practices and healthcare facilities statewide across every regional service area, including Seattle, Spokane, Tacoma, Vancouver, Bellevue, Everett, Kent, Renton, Yakima, Bellingham and Olympia.
