©2020 Community Health Plan of Washington, Phone: 1-800-944-1247 The non-contracted provider payment dispute process can not be used to challenge payment denials that result in zero payment. Your comments help us improve the quality of our programs and services. Training courses are available on the CMS Medicare Learning Network website. CHNW is a Washington State licensed Health Care Services Contractor duly registered under the laws of the State of Washington to provide health care coverage. New technologies are evaluated on an ongoing basis. Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514) Additional information is available at www.chpw.org or by … Member Benefit grids act as a reference guide and not a guarantee of coverage. Medication Therapy Management Program (MTMP) Policy (PM556) Providers may see a Friday date on their Remittance Advice. MA Pharmacy Plan 008 Community Health Plan of Washington (CHPW) were founded in 1992 by Washington’s community health centers. Mailing Address : Community Health Plan of Washington 1111 3rd Ave, #400 Seattle, WA 98103 Portal Support : Technical difficulties, new account setup, password reset, training request or any assistance needed E-mail : Portal.Support@chpw.org Phone : 206-652-7178 Claims may be submitted to : CHPW Claims P.O. Community Health Plan of Washington is an HMO plan with a Medicare contract. Pricing Policy (Default, By Report, and Non-Covered Codes) (OP647) CHPW covers members for 100% of billed charges for preventive and up to the benefit amount for comprehensive services. To learn more about the decision process or whether a specific new technology is covered by Community Health Plan of Washington, please call our Customer Service team at 1-800-942-0247 (TTY Relay: Dial 711), Monday through Friday, 8:00 a.m. to 8:00 p.m. Non-Contracted Provider: In accordance with the Medicare Managed Care guidance, non-contracted providers have appeal rights. www.RadMd.com or (888) 899-7804. Business Profile. Payment dispute rights apply to any claim there is a disagreement between the non-contracted provider and CHPW regarding the decision to pay for a different service than the billed service. Community Health Plan Of Washington is an Oregon Domestic Non-Profit Corporation filed on January 9, 2009. Reference our care guidelines and other information for providers. To enroll in a Community Health Plan of Washington Medicare Advantage plan, you must be eligible to receive Medicare Part A and Part B and live in our service area (Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Pierce, Okanogan, Skagit, Snohomish, Spokane, Thurston, Walla Walla,Whatcom, and Yakima counties in Washington state). ➔ ADA Dental Claims Form Please send completed forms by mail to: CHPW Claims P.O. Current policies that you need to care for members can be found below. Pre-Service Authorization requests for certain non-emergent imaging services are handled by National Imaging Associates (NIA). Community Health Plan of Washington staff and providers determine whether services are approved or denied. To see the changes effective January 1, 2020, please review the Annual Notice of Changes (ANOC) for all of our 2020 plan options.. You must ask for a fair hearing within 120 days of the date on the health plan’s letter with a decision. Our process includes the use of prior authorization, concurrent review, and post-service review to ensure appropriateness, medical need, and efficiency of health care services, procedures, and the appropriate place of service. UnitedHealthcare Community Plan of Kentucky supports the Kentucky state goals of increased access, improved health outcomes and reduced costs by offering Medicaid benefits to the following members: Children, from birth through 18 years of age, eligible for Medicaid under expanded pediatric coverage provisions of the Social Security Act. We follow these rules: Community Health Plan of Washington is committed to keeping up with new technologies. CHPW members have the right to language access services when they attend a health care appointment and may present a Language Assistance Card to their provider to request interpreting needs . Note: The vision benefit continues to be administered through Vision Service Plan (VSP), offering our members a number of options to … If CHPW upholds the initial payment denial following review of the appeal or does not make a decision within 60 calendar days from the date the appeal request was received, CHPW will submit the appeal request to the IRE for review. Enrollment in Community Health Plan of Washington Medicare Advantage Plan depends on contract renewal. Willamette Dental Group of Washington, Inc. 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