Prior Authorization in Washington
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Washington practices and billing companies at $2,100 per seat per month. Full time, worked during Washington business hours, inside your own system.
What is specific to Washington
Apple Health is administered through managed care organizations, each with its own authorization pathway.
Washington’s Medicaid programme is Apple Health. Practices with a meaningful Apple Health mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a prior authorization seat does in Washington
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Washington the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Washington business hours, not queued overnight
For the statute behind all of this — Washington’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Washington billing page.
Working Washington hours
Washington runs on Pacific time, 13 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 10pm to 6am, and 9pm to 5am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Washington hours and nobody else’s.
What it costs in Washington
$2,100
Per seat, per month, in US dollars — $25,200 a year for one full-time person, forty hours a week, on Washington hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Washington run $1,650 to $2,750; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Washington
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Washington practices?
Yes. Washington accounts are worked during Washington office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Washington?
Apple Health is administered through managed care organizations, each with its own authorization pathway.
How long do we have to file a Apple Health claim?
365 calendar days from the date of service, with a TCN assigned, measured from the date of service (or a fair-hearing decision, court order or retroactive certification). Resubmit, modify or adjust an initial claim within 24 months of the date of service (15 months for prescription drugs). Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: WAC 182-502-0150 — Time limits for providers to bill the agency.
When does a Washington payer have to pay a clean claim?
30 days — but expressed as a monthly-volume standard, not a per-claim deadline: 95% of the monthly volume of clean claims within 30 days, and 95% of the monthly volume of all claims paid or denied within 60 days (WAC 284-170-431(2)(a)). A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does prior authorization cost in Washington?
$2,100 per seat per month — $25,200 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Washington queue?
Washington is on Pacific time, 13 hours behind Rawalpindi. The shift here runs 10pm to 6am so your seat is at a desk for your full working day, shifting to 9pm to 5am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Apple Health as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Apple Health has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
More for Washington
Next step
One seat on your Washington work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com