Report an MCO Non-Payment Issue to AFHC
AFHC is collecting documented reports of delayed, denied, or missing MCO payments. This information will help identify patterns and support escalation with MCO leadership, the Health Care Authority, and policymakers.
Before contacting AFHC:
Confirm that the MCO is responsible for the payment.
Submit a written claim dispute or reconsideration to the MCO.
Request the exact reason for non-payment, any missing documents, and a case or reference number.
If the issue remains unresolved, submit an Apple Health billing complaint to HCA at:
https://www.hca.wa.gov/free-or-low-cost-health-care/contact-washington-apple-health-medicaid
Then email info@adultfamilyhomecouncil.org using the following subject line:
MCO NON-PAYMENT | [MCO NAME] | [AFH LICENSE NUMBER] | [COUNTY]
Please copy and complete the following:
AFH business name:
AFH license number:
County:
Provider/contact name:
Phone and email:
MCO name:
Type of service or payment:
Approximate total amount unpaid:
Number of unpaid claims or payments:
Oldest unpaid service/payment date:
Reason provided by the MCO:
Was the service authorized? Yes / No / Uncertain
Is the provider’s Medicaid enrollment/revalidation active? Yes / No / Uncertain
Date the issue was submitted to the MCO:
Current status of the MCO dispute:
MCO case number available? Yes / No
Was a complaint submitted to HCA? Yes / No
Date submitted to HCA:
HCA case number available? Yes / No
How is the delayed payment affecting your AFH?
Permission:
[ ] AFHC may use my information anonymously in aggregate reports.
[ ] AFHC may identify my AFH when communicating with HCA or the MCO.
[ ] AFHC may contact me about legislative, media, or advocacy opportunities.
Important privacy notice:
Do not email resident names, birth dates, diagnoses, Social Security numbers, full Medicaid identification numbers, or unredacted claims and payment documents. AFHC will arrange a secure method if additional documentation is needed.
Reporting the issue to AFHC does not replace the MCO’s dispute process, an HCA complaint, or any applicable filing or appeal deadline.
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