community health plan of washington claims address

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. Note: If you are a Dual Eligible Special Needs Plan (SNP) member, please refer to the hardcopy Provider Directory to assist you in obtaining access to providers who accept both Medicare and Medicaid. Community Care Plan serves the health of our community through access to a high standard of health care and community resources. Your inquiry will be reviewed. CHIP is a health insurance plan for children under the age of 19 and is designed for families who earn too much money to qualify for Texas Medicaid programs yet cannot afford to … If you have contracting questions, please contact: provider.relations@chpw.org. Paper copies of the guidelines are available for members or providers on request, as well as at the links provided. In January 2020, CareFirst BlueCross BlueShield announced the acquisition of Trusted Health Plan (District of Columbia), Inc. (THP). Enrollment in Community Health Plan of Washington Medicare Advantage Plan depends on contract renewal. Training courses are available on the CMS Medicare Learning Network website. If you need hard copies of any of our materials, contact your Provider Relations Representative. Community participates in the Children's Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P). Emergency Fill Policy (PM516) Business Profile. This means we review new tests, drugs, treatments, and devices and new ways to use current tests, drugs, treatments, and devices. ➔ ADA Dental Claims Form Please send completed forms by mail to: CHPW Claims P.O. STAR Kids Program: 1-855-607-7827 We use information from your doctor to do this. Premiums Disclaimer: You must continue to pay your Medicare Part B premium. CHPW Claims The deadline is every Tuesday at 5 p.m. for payment the following Monday. Coronavirus Support. www.RadMd.com or (888) 899-7804. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. The non-contracted provider payment dispute process can not be used to challenge payment denials that result in zero payment. 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. Coverage Determinations and Exceptions Policy (PM554) 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. Due to COVID-19, HCA’s lobby is closed. You can search for a variety of health care providers: primary care doctors, specialists, mental health or substance use disorder treatment providers. CHPW is committed to Washington's health. MA Pharmacy Plan 009 Community Health Plan of Washington. If CHPW upholds the original claim denial, non-contracted providers have the right to ask the CMS contracted IRE to review the appeal. CHPW must make a decision regarding the appeal within 60 calendar days from the date the appeal request is received. Effective October 1, 2016, HCA will accept only electronic claims for Apple Health (Medicaid) services, except under limited circumstances. Starting August 1, 2013 CareFirst CHPD will accept claims electronically through Change Health Care ( Formerly Emdeon) - Payor ID: L0230 and will have electronic remittance/ direct deposit capability. Interested? resource for the process of billing and submitting claims to the Washington Health Care Authority (HCA). Providers may see a Friday date on their Remittance Advice. Members denied a service or referral have the right to submit an appeal. Customer Service is available Monday through Friday, from 8:00 a.m. to 5:00 p.m. Please fill out the below form or contact us at 1-877-600-5472 (TTY/TDD: 711). A Trillium Community Health Plan representative may contact you regarding your inquiry. In this section, learn how to request prior authorization (PA) for services, submit claims, access provider billing guides and fee schedules, and find hospital reimbursement information. Please submit your Review and or Payment Dispute to: Community Health Plan of Washington The guidelines are intended to help guide providers in their care of our members including CHNW Cascade Select, CHPW Medicare, CHPW Apple Health-Integrated Managed Care, and CHPW Behavioral Health Services Only members. Payment dispute rights apply to any claim the provider contends the amount paid for a covered service is less than the amount that would have been paid by Original Medicare. Providers can be reimbursed for services rendered by submitting the ADA form below. Appeal rights apply to any claim CHPW has denied payment. Providers can be reimbursed for services rendered by submitting the ADA form below. Pharmacy Review of Coverage Redeterminations (PM555) We handle new technology requests for a specific member in a timely manner. All of our providers must be compliant with state and federal regulations. Washington Apple Health (Medicaid) Integrated Managed Care (IMC) Our plan offers a range of physical and behavioral health benefits. Your comments help us improve the quality of our programs and services. Transition Process Policy – MA (PM553). TALK TO AN EXPERT; Click here to schedule a plan review. Business Intelligence Portal. MA Value Plan 016. This is to ensure the medical necessity and appropriateness of care are met prior to services being delivered. A Increase font size. If you have questions, call Customer Service for help. Our decisions are fair and equal. A Reset font size. Please take a few minutes to complete a brief survey about our providers. For pharmacy coverage determination, please call 1-800-417-8164. Community Health Plan Of Washington was founded in 1996, and is located at 1111 3rd Ave Ste 400 in Seattle. You can also go to wahealthplanfinder.org or call 1-855-WAFINDER (1-855-923-4633) TTY/TTD 1-855-627-9604 to choose UnitedHealthcare Community Plan. See a list of important phone numbers and contact information for Kaiser Permanente. Prior Authorization review is the process of reviewing certain medical, surgical, and behavioral health services. Requests for payment disputes must be filed within 120 calendar days of the PRA. They are processed as prior authorization requests. A Decrease font size. Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. We look forward to continuing service to our 35,000 enrollees in the District. You will need Adobe reader to open PDFs on the site. 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. 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. Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514) 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). 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