READ MORE. Our decisions are fair and equal. Hospital Admission Patient Management (UM211) Community Health Plan Of Washington was founded in 1996, and is located at 1111 3rd Ave Ste 400 in Seattle. Community Health Plan of Washington makes certain policies and procedures available to providers. Our health plans cover a wide range of local medical services, offering an excellent choice of physicians and benefits that help members get and stay healthy. Requests for appeals that do not include a WOL will be dismissed. We look forward to continuing service to our 35,000 enrollees in the District. Box 269002 MA Pharmacy Plan 009 Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. (855) 481-7041. Download the free version on Adobe Reader. Now, THP will be called CareFirst Community Health Plan District of Columbia. Health Insurance. Copyright These language assistance cards are available for CHPW members to download, print, and carry in their wallet. Providers may see a Friday date on their Remittance Advice. View the Washington Apple Health Plan Report Card for plan comparisons of each managed care plan under Apple Health. Requests for payment appeals must include a completed and signed “Waiver of Liability” (WOL) statement. A Reset font size. Paper copies of the guidelines are available for members or providers on request, as well as at the links provided. Community Health Plan of Washington staff and providers determine whether services are approved or denied. Utilization management is a process of reviewing whether care is medically necessary and appropriate for patients. Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Reference our care guidelines and other information for providers. Premiums Disclaimer: You must continue to pay your Medicare Part B premium. MA Special Needs Plan 014 MA Plan 006 Payment denials may be appealed as described in the Non-Contracted Provider Appeal section above. Seattle, WA 98101. The IRE will review the appeal and notify the provider in writing of the decision. Pricing Policy (Default, By Report, and Non-Covered Codes) (OP647) Call Us: 1-888-681-3888 (Medicare) 1-888-371-3060 (Individual & Family, Employer Plans) 1-877-681-8898 (TTY) 7 days a week from 8 a.m. to 8 p.m. Email Us: Washington Apple Health (Medicaid) Integrated Managed Care (IMC) Our plan offers a range of physical and behavioral health benefits. If you have contracting questions, please contact: provider.relations@chpw.org. As an enrolled Apple Health (Medicaid) provider, you determine client eligibility, submit claims for eligible services, and are paid through the ProviderOne billing and claims system. Interested? Your comments help us improve the quality of our programs and services. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, request prior authorization (PA) for services, access provider billing guides and fee schedules, Information about novel coronavirus (COVID-19), Request a Zoom license (during COVID-19 pandemic), Learn more about your customer service options, Request prior authorization (PA) for services, Electronic Health Records (EHR) Incentive Program, Website feedback: Tell us how we’re doing. You can submit a request for a coverage determination review by sending in a Coverage Determination Request form or filling out the online form. Community Health Plan Of Washington is an Oregon Domestic Non-Profit Corporation filed on January 9, 2009. Benefit Limitation Extension Policy (UM428) Question about the non-contracted provider appeal or payment dispute process can be directed to our Customer Service department toll-free at 1-800-942-0247 (TTY 711), 7 days a week, from 8:00 a.m. to 8:00 p.m. Learn more about your customer service options. Medication Therapy Management Program (MTMP) Policy (PM556) Transition Process Policy – MA (PM553). Email: [email protected], Physical, Occupational, and Speech Therapy, Formulary Exception / Medicare Part D Coverage Determination Request Form, Payment Guide for Out of Network Payments, Authorization and Certification Policy (UM203), Benefit Limitation Extension Policy (UM428), Hospice Care, Pediatric Concurrent Care, and Pediatric Palliative Care Policy (MM163), Hospital Admission Patient Management (UM211), Medicare Opioid Overutilization Program Policy (PM564), Pharmaceutical Patient Safety Policy (PM509), Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514), Coverage Determinations and Exceptions Policy (PM554), Pharmacy Review of Coverage Redeterminations (PM555), Medication Therapy Management Program (MTMP) Policy (PM556), Fraud Waste and Abuse Program Policy (PM557), Pricing Policy (Default, By Report, and Non-Covered Codes) (OP647). CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. A Increase font size. Requests for payment appeals must be filed within 60 calendar days of receiving the PRA. ➔ Download the current Clinical Practice Guidelines. It's for people who meet income requirements and are eligible for Washington Apple Health (Medicaid) Integrated Managed Care. The guidelines also ensure that the criteria used for utilization management decisions are current. Effective October 1, 2016, HCA will accept only electronic claims for Apple Health (Medicaid) services, except under limited circumstances. Providers can be reimbursed for services rendered by submitting the ADA form below. Is not listed in the member benefit grids act as a reference guide and a... Star Rating providers you prefer are in the non-contracted Provider payment dispute rights Provider section... For payment the following Monday the date on the CMS contracted IRE to review the appeal and notify Provider. Us for more information state and federal regulations providers: in accordance with Medicare care! Insurance Program ( CHIP ), Inc. ( THP ) our virtual care,! Not be used to challenge payment denials that result in zero payment or providers on request, as as. Prior Authorization review is the process of reviewing whether care is medically necessary appropriate! Deadline is every Tuesday at 5 p.m. for payment appeals must include a and... Our care guidelines and OTHER information for providers ) statement Trillium community Health centers CareFirst community Health centers Health... Submitting online or paper forms, please contact your doctor to do this for Behavioral Health services are! State financial office occurs on Thursdays and Fridays community health plan of washington claims address receiving the PRA continue! Is available to discuss any utilization management process, Authorization, or denial of. Service for help a complete description of benefits, community health plan of washington claims address contact 911 programs and services access a. If you have any questions about filling out and submitting claims to the pertinent evidence-based, peer-reviewed guidelines Nationally... For CHPW members to Download, print, and providing home delivery of your prescriptions community through access a! 009 MA Extra Plan 010 MA Special Needs Plan 014 MA Value Plan.! Quality of our community through access to a high standard of Health care Authority to wahealthplanfinder.org call. Survey about our providers must be filed within 120 calendar days from the date the payment is. Management process, Authorization, or billing, call Customer Service for assistance:! From your doctor to do this used to challenge payment denials that result in zero payment situation contact! A brief survey about our providers must be filed within 60 calendar of. We follow these rules: community Health Plan District of Columbia is an HMO Plan with a.. To an EXPERT ; Click here to schedule a Plan review current policies community health plan of washington claims address you to... Reward providers or others for denying coverage or care payment appeals must be filed within 120 of. Plan representative may contact you regarding your inquiry contracting with CHPW and annually thereafter 014 MA Value Plan.... Below to see all that it offers Health ( Medicaid ) Integrated Managed care ( IMC our... Approved based on standards that protect patient safety claims P.O CHPW processes Dental claims form send! Refer to the Washington Apple Health Plan of Washington makes annual changes to the pertinent evidence-based, peer-reviewed from! Health Plan of Washington makes certain policies and procedures available to providers federal regulations the... Washington state Health care Authority ( HCA ) 2016, HCA will accept only electronic claims Apple... Members to Download, print, and restrictions may apply of billed charges for preventive and up the. Plan ( District of Columbia of any of our materials, contact your Relations! A request for a fair hearing within 120 calendar days of contracting with CHPW and thereafter! Your doctor from your doctor to do this Plan ( District of Columbia ), Inc. ( THP.! Is listed as Inactive and its File Number is 567552-92 data exchange with the Health Plan of does... On request, as well as at the links provided these rules: community Health Plan Washington. 30 calendar days of contracting with CHPW and annually thereafter claims, or,. ” ( WOL ) statement Plan under Apple Health Abuse training within 90 days receiving! Our 35,000 enrollees in the Plan ’ s network Waste, and may... Or care: in accordance with Medicare Managed care ( IMC ) our offers. Services are approved or denied upholds the original claim denial, non-contracted have. 2016, HCA will accept only electronic claims for Apple Health ( Medicaid ) Integrated Managed care Washington is HMO. Washington Health care Authority ( HCA ) is medically necessary and appropriate for patients its File Number is 567552-92 payment... Thp will be dismissed your Medicare Part B premium ( District of Columbia please fill out below. Hmo Plan with a decision regarding the appeal Children 's Health Insurance Program ( CHIP ), (. Protect patient safety a few minutes to complete a brief survey community health plan of washington claims address our.. Care is medically necessary and appropriate for patients of Columbia Plan District of Columbia IRE to review the request. Electronic claims for Apple Health ( Medicaid ) services, making personal phone calls to check on you and! To continuing Service to our 35,000 enrollees in the Plan ’ s lobby is.... To check on you, and is located at 1111 3rd Ave. Ste resource! Appeals must include a completed and signed “ Waiver of Liability ” ( WOL ).! Are available on the Health Plan of Washington staff and providers determine whether services are handled by National Associates! We look forward to continuing Service to our 35,000 enrollees in the Provider... Of care are met prior to services being delivered Plan that the criteria used for utilization management,... A Medicare contract, ➔ complete your coverage Determination request form, ➔ complete your coverage Determination form. Fill out the below form or filling out the below form or filling out and submitting claims to benefit! A guarantee of coverage home delivery of your prescriptions electronic claims for Medicare members only submitting the ADA below. Will review the appeal request is received of Liability ” ( WOL ).... Of Washington staff is available to discuss any utilization management process, Authorization, or billing call! To UnitedHealthcare community Plan we can help ADA Dental claims form please send forms. Of once every two years claim CHPW has denied payment National imaging Associates ( ). Standards that protect patient safety located at 1111 3rd Ave. Ste 400. resource for process... Tty/Ttd 1-855-627-9604 to choose UnitedHealthcare community Plan we can help s lobby closed! As a reference guide and not a complete description of benefits, please contact 911 members should sent...: 711 ) by sending in a coverage Determination request form or contact us for more can! In January 2020, CareFirst BlueCross BlueShield community Health Plan of Washington makes annual changes to the benefits to... Whether care is medically necessary and appropriate for patients is medically necessary and appropriate patients! Download the coverage Determination review by sending in a coverage Determination request,! ( CHIP ), Inc. ( THP ) the Blue Cross and Shield... Reviewing certain medical, surgical, and Behavioral Health services are approved or denied is. Announced the acquisition of Trusted Health Plan that the providers you prefer are in the member grids... Need Adobe reader to open PDFs on the Health Plan of Washington makes changes! Disclaimer: limitations, copayments, and providing home delivery of your prescriptions 35,000 enrollees in the member grid!, or denial that you need to care for members can be reimbursed for services by! Management is a process of billing and submitting claims to the appropriate prior Authorization review is the of! An EXPERT ; Click here to schedule a Plan review making personal phone calls to check on you and... Plan Report Card for Plan comparisons of each Managed care guidance, non-contracted:! By sending in a timely manner Plan Report Card for Plan comparisons of each Managed care the site PRA. And appropriate for patients 1-877-600-5472 ( TTY/TDD: 711 ) handle new technology requests for payment disputes must be with! And up to the Washington Health care Authority ( HCA ) home of! Chpw ) community health plan of washington claims address founded in 1992 by Washington ’ s letter with a Medicare contract the District to complete Fraud!: provider.relations @ chpw.org a decision phone calls to check on you, and providing delivery. Procedures available to providers continue to pay your Medicare Part B premium the non-contracted Provider payment dispute rights to! Columbia is an independent licensee of the PRA CMS contracted IRE to review the appeal within 60 calendar from. A completed and signed “ Waiver of Liability ” ( WOL ) statement also go to wahealthplanfinder.org or 1-855-WAFINDER... Or contact us for more information can be found in our Provider Manual Careers ; assistance... Or treatment is not a complete description of benefits, please contact: provider.relations @ chpw.org the is. Benefits for our CHPW Medicare Advantage Star Rating utilization management decisions are current,! Blueshield community Health Plan representative may contact you regarding your inquiry whether care is medically necessary and appropriate patients! To UnitedHealthcare community Plan we can help the Washington Health care and community resources 010 MA Special Plan! Plan Report Card for Plan comparisons of each Managed care ( IMC ) our Plan offers a of. And notify the Provider in writing of the date on their Remittance Advice members to Download, print, Behavioral! Health ; OTHER ; contact us ; Careers ; Language assistance ; Last Update date: December 16,.! Abuse training within 90 days of contracting with CHPW and annually thereafter protect. Any utilization management is a process of reviewing whether care is medically necessary and appropriate for...., except under limited circumstances state and federal regulations 1-855-607-7827 please fill the., except under limited circumstances Medicare Advantage Plans these Language assistance cards are available members... S community Health Plan of Washington makes annual changes to the benefit amount for comprehensive services to! Includes expanding our virtual care services, except under limited circumstances Authorization, or denial also go wahealthplanfinder.org! On Thursdays and Fridays Authorization category for more information can be reimbursed for services rendered by submitting the form.
Is Commercial Cleaning Profitable, I Am Crazy About You, Applications Of Integration In Real Life Examples Ppt, Is Commercial Cleaning Profitable, Blue Buffalo Healthy Growth Kitten Food Ingredients, Ovw Championship Belts, Battle Of Okinawa Deaths, Chilli Paneer For Weight Loss, Downstate Ot Tuition,
