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WA HCA 13-835: General Information for Authorization

Washington's Health Care Authority requires the HCA 13-835 as the first page of any fee-for-service Apple Health prior authorization or limitation extension request sent by fax, covering medical, DME, dental, home health, therapies and many other programs. A clinician meets it whenever a faxed request goes to HCA Authorization Services. Its program (Org) and service type codes identify the kind of service being requested.

Who completes it

The requesting provider completes and types every field: program (Org) and service type codes, client details, requesting, billing and referring NPIs, the service and codes requested, diagnosis, place of service and comments.

Submitting and payment

How to submit it
Enter the request in ProviderOne by direct data entry, or fax it to HCA Authorization Services as page one, followed by any service-specific form and supporting documents.
Who pays
For codes without a set allowable, enter the dollar amount requested in dollars and cents; codes with a set allowable take units or days instead.

Good to know

  • Org codes identify the program, for example 502 DME, 504 home health, 508 medical, 511 outpatient procedures and diagnostics, 519 respiratory and 525 ABA services.
  • Mark Expedite only when the client's health, life or ability to regain function is at risk.
  • When a client ID is still pending, HCA can build a reference PA with a placeholder ID, updated once the client ID is known.
  • Service-specific forms such as 13-847 home health, 13-772 hearing aids and 13-785 bariatric surgery follow this page.

Get the official form

Download the current version from the source each time; forms change without notice.

General Information for Authorization

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Is the HCA 13-835 required for every Washington Medicaid PA fax?

For faxed fee-for-service Apple Health requests, yes. HCA treats it as page one of any faxed medical, DME or dental prior authorization or limitation extension request. HCA also accepts requests by direct data entry in ProviderOne, and Apple Health managed care members use their own plan's prior authorization forms.

What code qualifiers does the 13-835 use?

Field 20 takes T for CDT, C for CPT, D for DRG, P for HCPCS, I for an ICD diagnosis code, R for revenue code and S for an ICD procedure code. Field 21 then holds each national code, with modifiers, units or a dollar amount, and a manufacturer part number for DME.