Behavioral Health

 Here you will find behavioral health forms and resources helpful to Washington Community Plan providers.

Behavioral Health Provider Forms

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Young children’s mental health evaluations

The Washington state legislature recently passed a bill that will change Apple Health’s policies for mental health evaluations for children from birth to age 5, now known as the Mental Health Assessment for Young Children (MHAYC).

Changes under the new MHAYC policy include:

  • Reimbursement for up to 5 sessions
  • Reimbursement to health care professional travel costs for assessments performed in home or community settings
  • Requirement to use the DC:05 diagnostic classification system

Travel reimbursement details

Travel for in-network health care professionals will be reimbursed in accordance with your contract if these qualifications are met:

  • Conducting a mental health assessment
    • CPT codes 90791, 90792 or H0031
  • For a child from birth to age 5 up until their 6th birthday
  • For a session performed in the child or family’s home or in a community setting

To request reimbursement, you need to complete the Community Plan of Washington MHAYC Provider A-19 Vendor Invoice Voucher Form, including:

  • The service date of the assessment
  • The ProviderOne client ID
  • Addresses of starting and ending point
  • Miles from starting point to ending point
  • Mileage rate (prepopulated on the form)
  • Submit invoices to The invoices will be confirmed to claims based on the eligibility requirements for reimbursed outlined here. If all requirements are not met, UnitedHealthcare can’t adjudicate the claim.

Please submit the invoices no later than 60 days from an adjudicated supporting claim.

Questions:  Please submit any questions or concerns to