Medical Billing Services in Washington State

PRMS Billing Solutions runs complete billing and revenue cycle management for Washington providers, from Seattle, Bellevue, and Tacoma to Spokane, the Tri-Cities, and rural eastern Washington. Washington billing has its own vocabulary: Apple Health for Medicaid, ProviderOne for claims, and two separate Blues (Premera and Regence) that split the commercial market. We manage eligibility, coding, claims, denials, AR, and credentialing across all of it, end to end.

Medicare billing in Washington

Washington Part B claims are processed by Noridian Healthcare Solutions, the Medicare Administrative Contractor for Jurisdiction F. We submit to Noridian daily and screen claims against its local coverage determinations. Washington's Medicare Advantage market features Kaiser Permanente Washington, Regence, Premera, Humana, and UnitedHealthcare, and we verify MA enrollment at eligibility so senior claims route to the right plan every time.

Apple Health (Washington Medicaid) billing

Washington Medicaid is Apple Health, with enrollment and fee-for-service claims running through the ProviderOne system. Most members are in managed-care plans: Molina Healthcare of Washington (the state's largest Medicaid plan), Community Health Plan of Washington, Coordinated Care (Centene), UnitedHealthcare Community Plan, and Wellpoint. Plans organize around regional service areas, so the same practice can see members from several MCOs in one day. We verify each member's plan before the visit and keep ProviderOne enrollment current.

Commercial payers we bill in Washington

Washington's commercial market is split between two Blues: Premera Blue Cross (with its huge Microsoft and Amazon-adjacent employer book) and Regence BlueShield, separate companies with separate networks, portals, and appeal processes. Kaiser Permanente Washington runs its own integrated HMO, and First Choice Health provides a strong regional PPO network. Aetna, Cigna, and UnitedHealthcare round out the employer market. Confusing the two Blues is the classic Washington billing error, and we never make it.

Specialties we serve across Washington

We bill 25+ specialties across Washington, including its high-volume outpatient fields: behavioral health (a major Apple Health priority), family medicine, orthopedics, physical therapy, telehealth (deeply embedded in WA care delivery), dermatology, and urgent care.

Why Washington practices choose PRMS

Washington's recurring leaks: Premera claims filed to Regence (and vice versa), Apple Health claims sent to ProviderOne when the member sits with an MCO, and L&I workers'-compensation claims (Washington runs a state-fund system) billed like ordinary commercial claims. We sort payer, plan, and program before the visit, appeal what is wrongly denied, and report weekly. Credentialing with ProviderOne, both Blues, and every major Washington payer is free for billing clients.

Related services

Explore our full medical billing & RCM services, denial management, and provider credentialing & payer enrollment (free for billing clients), or browse all 25+ specialties we bill and other states we serve.