Beginning January 1, 2025 Washington State Medicaid (Apple Health) approved birth doula support for all it’s members. See: Washington State Department of Health Birth Doulas Website. Here are the steps I have gathered thus far to participate in the program and bill for doula support via Apple Health. I’m already a Traditional Healthcare Worker in the state of Oregon, so I was able to use my THW credential to become certified in Washington, too using their Out of State Endorsement process. Note: I’m just a doula navigating this for the first time and documenting what’s working and not working, I’m not associated with WHA in any way.

How to enroll as a provider (doula) with Apple Health

To become an Apple Health (Medicaid) birth doula, providers must:

1. Complete voluntary birth doula certification application with DOH
   • Mail completed application and other documents to:
     Birth Doula Credentialing
     P.O. Box 47877
     Olympia, WA 98504-7877
2. Obtain a National Provider Identifier number (NPI)
3. Enroll with ProviderOne (billing and claims system)
   • Once enrolled, use this ProviderOne login page

Once approved, you’ll receive a Birth Doula Certification credential with credential number in the mail. It expires after two years. Then you’re ready to accept Apple Health members as your doula clients!

If you are already a THW provider in Oregon

1. Complete voluntary birth doula certification application with DOH
   • On the application, select Out of State Endorsement
   • Complete the Credential verification form (linked within the application) enabling Washington to obtain your Oregon credential
   • Provider an attestation that you have successfully completed culturally congruent ancestral practices training and education
   • Provide documentation of your doula training certification on their approved list
     • If your doula training certification isn’t on their approved list, use the ancestral pathways competency by attesting you have completed training that is substantially equivalent and include 3 written letters of recommendation from industry professionals (a doula, midwife, or licensed provider). There is a provided template at the end of the application for the letters of recommendation.
   • When I applied in 2024 I also had to include 10 CEUs but this may not be required now (2025)
   • Mail completed application and other documents to:
     Birth Doula Credentialing
     P.O. Box 47877
     Olympia, WA 98504-7877
2. You should already have an NPI, if so, skip that step. Or click here to obtain an NPI.
3. Enroll with ProviderOne (billing and claims system) | Enrollment Instructions
   • Agency: HCA
   • HCA billing type: BL-Billing (you are a billing provider)
   • Enter all your personal details, proceed; save the Application #
   • Complete all the screens listed such as Locations, Specializations, Certifications, etc.
   • You’ll receive an application number. Use this number to check the status of your application.
   • Check the status of your application here
4. Once enrolled, use this ProviderOne login page

Once approved, you’ll receive a Birth Doula Certification credential with credential number in the mail. It expires after two years. Then you’re ready to accept Apple Health members as your doula clients!

Doula services updates – sign up!

HCA is working with partners to finalize birth doula rules. This process will not be complete by January 1, 2025. HCA plans to use the emergency rulemaking process outlined in the Administrative Procedure Act (Chapter 34.05 RCW).

Emergency rules are effective immediately upon filing with the Washington State Office of the Code Reviser and for 120 days from the filing date. The emergency rules will allow the doula benefit to go live on January 1, 2025 while HCA continues working with partners to complete the standard rulemaking process.

To stay connected to our doula work, subscribe to the doulas mailing list.

How to Bill a Fee For Service Claim for Doula Support in the ProviderOne Portal

Updated 7/1/2025

• Make sure that you have the correct taxonomy assigned to your ProviderOne username.
  The Doula Taxonomy is 374J00000X
  You need to have the right taxonomy to bill for doula services or your claim will be denied.
• Check client eligibility
  • Login to ProviderOne
  • Click “Client Benefit inquiry”
  • Enter the client information and dates
  • Check the client’s Benefit Service Package. (CNP, Medicare, or Managed Care, etc.)
  • Reference Appendix E of Provider One Billing and Resource Guide pg 110; this will show what each benefit service package covers.
  • Natalie To Do: List them here
• Submit the claim within ProviderOne
• Click Online Claim Entry, choose professional claim.
  • Asterisk = required. Otherwise, skip it. Enter as little information as possible.
• Enter their client ID
• Click the Plus to open the Additional Subscriber/Client information section and enter information here
• Place of service, click the drop down
• Diagnosis code #1 is required. See table below
• Basic line item information (same as the 1500 form)
  • can skip place of service if you included it up above
  • Use Modifier as indicated on the table below. 
  • Diagnosis pointer = 1
  • Submitted charges: usual and customary charges (IE what you would charge a private client, not just what WHA will pay, it could go up!)
• Skip all fields without asterisks
• Click Add service line item button. IMPORTANT!
  • This will make a new line with the information you entered above.
  • If you need to add a second line, scroll up, enter new information, add a second line.
• If you need to change something, click the hyperlink “1” next to that line item to edit it.
• Scroll up to the top and hit Submit Claim. 
  • Submit backup? Say no/cancel
  • You’ll get a TCN claim number, save it.
  • You have to click the SUBMIT button again here or it will not go through!!

Birth Doula Coverage Table

Note: HCA has designated 6 units (90 minutes, 1 unit = 15 minutes) for a comprehensive postpartum visit, to support Apple Health (Medicaid) clients having tailored postpartum birth doula services. The remaining 74 units (18.5 hours) may be used for either additional prenatal or postpartum visits.

Example Claim Payments

Example A (minimal)
$750 Prenatal intake (two hours)
$200 Prenatal visit (two hours)
$750 Labor and delivery support
$200 Postpartum visit (two hours)
= $1900

There are 20 hours total available for additional visits beyond the initial prenatal intake. You may add additional prenatal and postpartum visits as needed by your client up to a maximum of 20 additional hours. Here is an example of how you could potentially maximize the doula benefit for your client.

Example B (maximum)
$750 Prenatal intake (two hours)
$200 Prenatal visit (two hours)
$200 Prenatal visit (two hours)
$200 Prenatal visit (two hours)
$750 Labor and delivery support
$400 Postpartum visit (four hours)
$400 Postpartum visit (four hours)
$200 Postpartum visit (two hours)
$200 Postpartum visit (two hours)
$200 Postpartum visit (two hours)
= $3500

Check Claim Status

• After you submit your claim, you can look on Claim Inquiry to check the status after about 30 minutes
• Enter TCN, client id, etc.
• Click the blue TCN hyperlink, you’ll see claim details you submitted.
• If it has a “Check or EFT trace number” I think this means it’s been paid? Same day you won’t have a check number yet.
• Click the blue hyperlinks that will give you details about why it was denied 
• View Payment blue hyperlink it will show Remittance

Getting a ProviderOne Error Message?

• Log out correctly by hitting the power button. Don’t hit X’s
• Clear internet history and try again
• Disable pop up blockers so you can get pop ups

Timing

• Clients are eligible to receive birth doula services during any point in pregnancy, childbirth (inclusive of any end-of-pregnancy outcome), or during the postpartum period up to 12-months.
• You must bill within 365 days of the date of service (IE, the date of each visit)

Documentation requirements
All providers must satisfy the documentation requirements in WAC 182-502-0020 and this guide, regardless of whether the provider maintains hand-written or electronic client health care records. All documentation must be maintained for at least six years and must be submitted to HCA upon request.

The following must be documented in the client’s health care record:

• Consent for services to be signed at the initiation of care
• The date and time/duration of services and information substantiating the services provided.
• The nature of the care and service(s) provided during each visit
• Any coordination with medical or other care providers
• Any referrals and coordination efforts with community resources or community supports
• If screening is provided using a validated screening tool, the name of the tool, the score, and any communication following a positive screening including referrals to community resources, coordination with clinical care team, etc.

Charting overview

Each provider must maintain a client health care record for each client that states the services provided and justifies how those services support provider reimbursement.

Prenatal intake visit
The following are required components of the prenatal intake visit and must be documented in the client’s health care record:

• The date and time/duration of services, minimum two-hour visit
• A completed and signed consent for services form
• Provide an overview of the Apple Health birth doula benefit
• Co-design a plan of care across antepartum, delivery, and postpartum periods, as appropriate
• Initiate discussion and implementation of birth plan or client/family preferences for care
• Support the client in establishing care as needed, including clinical pregnancy care, behavioral health services, dental services, etc. Coordinate with the MCO, if needed, to assist the client in accessing desired services, timely appointments, or any other care coordination or case management need
• Review the client’s health history including any previous pregnancies, births, and loss of life
• Coordinate with medical providers regarding mental and emotional health screenings, and if appropriate, support symptom reduction through care navigation or peer support. See Screening of mental health conditions during pregnancy and postpartum in HCA’s Pregnancy-Related Services Billing Guide
  • Note: Coordination of care around perinatal mental health is broad and includes but is not limited to the following:
    • Discussing with the client the screening they should receive from their clinical pregnancy provider
    • Discussing and referring the client to available community supports or resources
    • Making a plan for the client to bring up concerns with the clinical pregnancy provider
    • The birth doula attempting to directly contact the provider
• Review social determinants of health (SDOH) and other social-related health needs. Provide resources and support guided by client or family priorities
• Assess family and other relational support networks

What is covered?
HCA covers birth doula services with limitations. Birth doula services must meet all the following:

• Be preventive in nature according to 42 C.F.R. 440.130(c)
• Provide physical, emotional, and informational support to pregnant, birthing, and postpartum people

HCA pays for the following birth doula services:

• One prenatal intake visit billed only once per pregnancy
• Continuous labor and delivery support billed only once per pregnancy
• One comprehensive postpartum visit per pregnancy
• Additional prenatal and postpartum visits limited to 20 hours per pregnancy

Services not included in the birth doula benefit

HCA does not pay for the following services when provided by a birth doula:

• Childcare
• Chore services including, but not limited to, shopping and cooking
• Group services
• Phone calls, text messages, and emails
• Documentation time
• Travel time and mileage

Resources and Links

• HCA Website https://www.hca.wa.gov/
  • Go to Billers, providers & partners > Submit Claims > Provider billing guides & fee schedules
• Questions? HCAdoulas@hca.wa.gov
• Log Into ProviderOne
• Provider One Billing and Resource Guide 
• Profiles
• Billing guide and fee schedule, under Birth Doulas
• Check status of your ProviderOne application
• Find a Doula covered under Washington Medicaid Apple Health
• WHA Doula Information Page

Gratitude

Thank you for reading, I hope this guide is helpful to you! If you have anything to add or change, please email me: nataliebroders@gmail.com

I’m not associated with the WHA in any way; I’m just a doula trying to share information with other doulas about what has worked for me as we all try to learn how to navigate this new world of billing insurance. This is information I have gathered through my own experience, emails from WHA, and online Zoom training sessions.

Warmly,

• Natalie