How to Use the Provider Directory

This provider directory can help you choose a health plan and participating provider, hospital, and pharmacy with the specified managed care program (i.e. Basic Health, Healthy Options or other program).

This directory gives the names of primary care providers (such as family practitioners, internists, and pediatricians), obstetric providers (for women who are pregnant), and specialists (such as cardiologists and dermatologists).  Although you may self-refer to see a primary care or obstetric provider, most health plans require prior authorization from the plan or a referral from your primary care provider to see specialists.  For more information, please call the health plan you choose.

Please note: The health plans provide information for this directory, which is updated monthly. If you believe the information shown is wrong, either contact the health plan directly or send an e-mail to the addresses shown at the bottom of the Provider Directory web page. The change will be verified and corrected.

How to Find More Information About the Health Care Programs
How to Search for Health Plans by County
How to Search for Individual Providers
How to Search for Hospitals or Pharmacies
Definitions of Terms Found in This Directory

How to Find More Information About the Health Care
Programs  
To learn more about each health care program, you can click on the hyperlink for that program (i.e. Basic Health (BH)). These links can be found on Provider Directory home page. Each health care program page will give a brief summary of the program, as well as provide links to the program’s Web site for more information.

How to Search for Health Plans by County  
To search for health plans available in a specific county, you can click on the health care program’s hyperlink, found on Provider Directory home page. You will see a link at the bottom of each program's popup box labeled “Search for Health Plans by County.” Click on this link to find the county you live in and the health plans available in that county.
Please note: You can only choose a health plan and providers in your county.

How to Search for Individual Providers  
You can find a provider who participates with a specific health care program (such as Basic Health) by selecting "Individual Provider" and clicking the Search button found on the Provider Directory home page.

In addition to finding a participating provider by name, type, or location, you can provide other information (such as city, ZIP Code, and provider gender preference) that will help narrow your search. Enter this additional information in the Search page that displays. 

Please note: Some health plans have included specialist providers in this directory, for searches by name (not by provider type, such as cardiologists). Most plans require a referral from your PCP to see specialists. Call the health plan for details on the referral process.

Also, the provider lists do not include alternative care providers (such as chiropractors and acupuncturists) or providers who are not doctors. (Exception: Registered nurse practitioners and physician assistants may be listed as primary care providers.) For more information on these types of providers available to you, and referral guidelines, please contact the health plan you choose.

How to Search for Hospitals or Pharmacies  
You can find a hospital or pharmacy that participates in a specific health care program by selecting "Clinic/Office, Hospital or Pharmacy" and clicking the Search button found on the Provider Directory home page.

In addition to finding a participating hospital or pharmacy by business name, type, or location, you can provide other information (such as city and ZIP Code) that will help narrow your search. Enter this additional information in the Search page that displays.

Definitions of Terms Found in This Directory  
Here are some terms found in this directory, and their definitions:

Contract Effective
The date a provider’s contract starts with a specific health plan.

Contract End
The date a provider’s contract ends with a specific health plan.

Physician/Clinic Code
The code that a health plan assigns to a contracting primary care provider (PCP) or clinic. When you enroll in a health plan through the Public Employees Benefits Board (PEBB) program, you will be required to provide your PCP's physician/clinic code on the enrollment/change form.

Health Care Authority (HCA)
The state agency that administers the Basic Health and Public Employees Benefits Board (PEBB) programs. The HCA contracts with health plans to provide health care services to members enrolled in these programs.

Health Plan
The insurance company that contracts with doctors, hospitals, and other providers to provide health care services.

Health and Recovery  Services Administration (HRSA)  
A division of the Department of Social and Health Services (DSHS), the state agency that administers the Children’s Health Insurance Program (SCHIP) and Healthy Options program (HO), Basic Health Plus (BHP), Washington Medicaid Integration (WMIP), Medicaid Medicare Integrated Project (MMIP), and General Assistance Unemployable Project (GAU). The HRSA contracts with health plans to provide health care services to members enrolled in these programs.

Obstetric Provider
A doctor whose training focuses on the care of women during and after pregnancy.

Practice Limits
Any conditions or restrictions a provider or clinic places on their services, such as the type of clients it will see (children only), its field of medicine (family practice), or the hours that it is open.

Primary Care Provider (PCP)
The doctor, nurse, or physician assistant who takes care of you to make sure you get all the health care you need. Your PCP knows your medical history and will send you to a specialist and other services when needed.

Specialist
A doctor whose training focuses on a particular area, such as cardiology (treatment of the heart) and dermatology (treatment of skin).