WA HCA 13-835 2016-2026 free printable template

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General Information for AuthorizationOrgService Type1.2. Client Information Name3. Client ID4. Living Arrangements5. Reference Auth #6. Provider Information Requesting NPI #7. Requesting Fax #8. Billing

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How to fill out WA HCA 13-835

01

Begin by obtaining the WA HCA 13-835 form from the Washington State Health Care Authority website or your local health office.

02

Fill out your personal information, including your name, address, phone number, and date of birth in the specified sections.

03

Indicate your household size and annual income to determine your eligibility for assistance.

04

Provide information about any health insurance coverage you currently have by checking 'Yes' or 'No' as applicable.

05

If applicable, list any other individuals in your household who are applying for health coverage.

06

Review the form for completeness and accuracy, ensuring all required fields are filled out.

07

Sign and date the application at the designated area to certify that the information provided is correct.

08

Submit the completed form as instructed, either online, by mail, or in-person, according to the guidelines provided.

Who needs WA HCA 13-835?

01

Individuals or families residing in Washington State who are seeking financial assistance for health care coverage.

02

Those who may not have adequate health insurance or are looking for coverage options under the Washington Health Care Authority programs.

03

Low-income individuals who meet certain criteria and require support to access medical services.

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What is WA HCA 13-835?

WA HCA 13-835 is a form used by the Washington State Health Care Authority for reporting specific health care-related information.

Who is required to file WA HCA 13-835?

Entities that provide health care services in Washington State, including hospitals and health care providers, are generally required to file WA HCA 13-835.

How to fill out WA HCA 13-835?

To fill out WA HCA 13-835, individuals or organizations must provide relevant health care data as specified in the instructions accompanying the form, ensuring all sections are completed accurately.

What is the purpose of WA HCA 13-835?

The purpose of WA HCA 13-835 is to collect data for the oversight and monitoring of health care services in Washington State, facilitating informed decision-making and policy development.

What information must be reported on WA HCA 13-835?

Information that must be reported on WA HCA 13-835 includes health care service types, patient demographics, utilization data, and financial information related to services provided.

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