P.O. Business Profile ... Community Health Plan of Washington. New technologies are evaluated on an ongoing basis. Requests for payment disputes must be filed within 120 calendar days of the PRA. Interested? We also look at medical standards. The company's filing status is listed as Inactive and its File Number is 567552-92. www.RadMd.com or (888) 899-7804. Health Insurance. Community Health Plan of Washington. The Washington State Health Care Authority and UnitedHealthcare Community Plan are encouraging care providers to learn more about how they may integrate this model into their practice. CHPW must make a decision regarding the appeal within 60 calendar days from the date the appeal request is received. 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. ➔ Download the current Clinical Practice Guidelines. Community Health Plan Of Washington was founded in 1996, and is located at 1111 3rd Ave Ste 400 in Seattle. 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. CHPW covers members for 100% of billed charges for preventive and up to the benefit amount for comprehensive services. Community participates in the Children's Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P). Community Health Plan of Washington is an HMO plan with a Medicare contract. Pharmacy Review of Coverage Redeterminations (PM555) Requests for payment appeals must be filed within 60 calendar days of receiving the PRA. Pricing Policy (Default, By Report, and Non-Covered Codes) (OP647) This is not a complete description of benefits, please contact us for more information. Due to COVID-19, HCA’s lobby is closed. Home › Provider Center › Provider Resources. Effective October 1, 2016, HCA will accept only electronic claims for Apple Health (Medicaid) services, except under limited circumstances. All clean claims submitted in a timely manner will be paid within 30 days in accordance with the provisions of the DC Prompt Payment Act of 2002. Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. Copyright Our representatives are available at 1-800-942-0247 (TTY Relay: Dial 711) seven days a week, from 8:00 a.m. to 8:00 p.m. Community Health Network of Washington and Community Health Plan of Washington use guidelines for chronic diseases (including medical and behavioral health conditions) and for preventive services, as listed below. 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. CHPW must make a decision regarding the payment dispute within 30 calendar days from the date the payment dispute is received. Community Health Plan of Washington makes certain policies and procedures available to providers. Phone: 1-800-440-1561 (TTY Relay: Dial 711) Email: [email protected] Mail: Community Health Plan of Washington 1111 Third Ave, Suite 400, Seattle, WA 98101 MA Pharmacy Plan 008 To see the changes effective January 1, 2020, please review the Annual Notice of Changes (ANOC) for all of our 2020 plan options.. 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. Each health plan has its own network of providers, hospitals, and pharmacies. A Increase font size. If you are currently enrolled in Washington Apple Health (Medicaid) and would like to change to UnitedHealthcare Community Plan we can help. You can submit a request for a coverage determination review by sending in a Coverage Determination Request form or filling out the online form. Eligibility: 1-800-562-3022 or submit questions online; Coverage, Claims & Billing: 1-800-562-3022, submit questions online, or find local help Contact Your Health or Dental Insurance Company The IRE will review the appeal and notify the provider in writing of the decision. For pharmacy coverage determination, please call 1-800-417-8164. We handle new technology requests for a specific member in a timely manner. Utilization management is a process of reviewing whether care is medically necessary and appropriate for patients. It's for people who meet income requirements and are eligible for Washington Apple Health (Medicaid) Integrated Managed Care. Benefit Disclaimer: Limitations, copayments, and restrictions may apply. Training courses are available on the CMS Medicare Learning Network website. The non-contracted provider payment dispute process can not be used to challenge payment denials that result in zero payment. Pharmaceutical Patient Safety Policy (PM509) Please submit your Review and or Payment Dispute to: Community Health Plan of Washington CHPW Claims All clinic staff – including CEOs, senior leaders, managers, clerical/admin staff, physicians, and other clinical staff – are required to receive this training. 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 . NURSE ADVICE LINE; 1-866-418-2920 (TTY Relay: Dial 711) CUSTOMER SERVICE; 1-800-942-0247 (TTY Relay: Dial 711) ADDRESS; 1111 Third Ave; Suite 400; Seattle, WA 98101; HOURS; 8:00 a.m. to 8:00 p.m. Our decisions are fair and equal. Plano, TX, 75026. They are processed as prior authorization requests. Community Health Plan of Washington (CHPW) were founded in 1992 by Washington’s community health centers. Paper Claims Submission Practices Changing 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: Benefit Limitation Extension Policy (UM428) If you have contracting questions, please contact: provider.relations@chpw.org. All guidelines are reviewed at a minimum of once every two years. Paper copies of the guidelines are available for members or providers on request, as well as at the links provided. If you disagree with the health plan’s decision to cover something, you can ask your health plan for a fair hearing. 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. Emergency Fill Policy (PM516) Premiums Disclaimer: You must continue to pay your Medicare Part B premium. STAR Program: 1-800-434-2347. STAR Kids Program: 1-855-607-7827 The Registered Agent on file for this company is Paychex, Inc. and is located … They are approved based on standards that protect patient safety. Members denied a service or referral have the right to submit an appeal. Payment denials may be appealed as described in the Non-Contracted Provider Appeal section above. MA Special Needs Plan 014 The deadline is every Tuesday at 5 p.m. for payment the following Monday. The Clinical Quality Improvement Committee (CQIC), which includes medical and behavioral health providers and quality specialists, participates in this review and approves any changes. Reference our care guidelines and other information for providers. Please note, CHPW processes dental claims for Medicare members only. Payment disputes are subject to CMS review as CHPW is required to pay non-contracted providers the same amount the provider would have received had the provider billed Original Medicare. Attn: CHPW Medicare Advantage Appeals & Grievances 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. If you have a life threatening emergency, please contact 911. Please take a few minutes to complete a brief survey about our providers. READ MORE. These language assistance cards are available for CHPW members to download, print, and carry in their wallet. Coverage Determinations and Exceptions Policy (PM554) The coronavirus is affecting our communities in Washington, and Coordinated Care wants us to all stay as safe and healthy as possible.While there isn’t a vaccine for coronavirus yet, we can all work to prevent it by washing your hands often with soap and water for at least 20 seconds and staying home when you are sick. Call 1-866-686-9323, TTY 711. Behavioral Health; OTHER; Contact Us; Careers; Language Assistance; Last Update Date: December 16, 2020 . Hospice Care, Pediatric Concurrent Care, and Pediatric Palliative Care Policy (MM163) You must ask for a fair hearing within 120 days of the date on the health plan’s letter with a decision. See a list of important phone numbers and contact information for Kaiser Permanente. Member Benefit grids act as a reference guide and not a guarantee of coverage. We use information from your doctor to do this. 1111 Third Avenue, Suite 400 Coronavirus Support. Claims for Medicaid members should be sent to Provider One. Appeal rights apply to any claim CHPW has denied payment. Please verify with the health plan that the providers you prefer are in the plan’s network. Medication Therapy Management Program (MTMP) Policy (PM556) A Decrease font size. Box 269002 Plano, Tx 75026-9002 Reference is made to the pertinent evidence-based, peer-reviewed guidelines from Nationally recognized agencies. View the benefits below to see all that it offers. Authorization and Certification Policy (UM203) ➔ Download the Coverage Determination Request Form, ➔ Complete your Coverage Determination Request online. MA Extra Plan 010 Non-Contracted Providers: In accordance with Medicare Managed Care guidance, non-contracted providers have payment dispute rights. Please fill out the below form or contact us at 1-877-600-5472 (TTY/TDD: 711). A copy of this PRA and supporting documentation must be submitted with the appeal request. 1111 3rd Ave. Ste 400. TALK TO AN EXPERT; Click here to schedule a plan review. Address 1100 New Jersey Avenue, S.E., Suite 840 Washington, DC 20003 Call Us Tel: (855) 326-4831 Tel: (202) 821-1100 CareFirst CHPDC Health and Wellness Centers. Seattle, WA 98101. If a service or treatment is not listed in the member benefit grid, refer to the appropriate prior authorization category for more information. 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. Important! (855) 481-7041. Community Health Plan of Washington does not reward providers or others for denying coverage or care. The data exchange with the state financial office occurs on Thursdays and Fridays. If you have questions, call Customer Service for help. CHPW cannot begin the appeals process without a signed WOL. CHPW is committed to Washington's health. 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. Providers are required to complete a Fraud, Waste, and Abuse training within 90 days of contracting with CHPW and annually thereafter. ProviderOne claims submission deadlines. 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. Community Health Plan of Washington staff and providers determine whether services are approved or denied. Enrollment in Community Health Plan of Washington Medicare Advantage Plan depends on contract renewal. More information can be found in our Provider Manual. ©2020 Community Health Plan of Washington, Phone: 1-800-944-1247 Providers and Locations. All requests are subject to current benefits and coverage limitations. 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This is to ensure the medical necessity and appropriateness of care are met prior to services being delivered. 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. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. Your comments help us improve the quality of our programs and services. Pre-Service Authorization requests for certain non-emergent imaging services are handled by National Imaging Associates (NIA). Community Health Plan Of Washington is an Oregon Domestic Non-Profit Corporation filed on January 9, 2009. Download the free version on Adobe Reader. This means we review new tests, drugs, treatments, and devices and new ways to use current tests, drugs, treatments, and devices. If CHPW upholds the original claim denial, non-contracted providers have the right to ask the CMS contracted IRE to review the appeal. 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. 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). We look forward to continuing service to our 35,000 enrollees in the District. Requests for payment appeals must include a completed and signed “Waiver of Liability” (WOL) statement. Business Profile. The guidelines also ensure that the criteria used for utilization management decisions are current. CareFirst CHPDC Resource Center MA Plan 006 Community Care Plan serves the health of our community through access to a high standard of health care and community resources. Providers may see a Friday date on their Remittance Advice. If you need hard copies of any of our materials, contact your Provider Relations Representative. 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. Community Health Network of Washington Cascade Select is a health insurance plan for individuals and families offered by Community Health Network of Washington (“CHNW”). Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…. Providers can be reimbursed for services rendered by submitting the ADA form below. View the Washington Apple Health Plan Report Card for plan comparisons of each managed care plan under Apple Health. We follow these rules: Community Health Plan of Washington is committed to keeping up with new technologies. Claim Share Print. If you have any questions about filling out and submitting online or paper forms, please contact Customer Service for assistance. Note: The vision benefit continues to be administered through Vision Service Plan (VSP), offering our members a number of options to … A Trillium Community Health Plan representative may contact you regarding your inquiry. Hospital Admission Patient Management (UM211) In January 2020, CareFirst BlueCross BlueShield announced the acquisition of Trusted Health Plan (District of Columbia), Inc. (THP). Transition Process Policy – MA (PM553). MA Value Plan 016. Providers can be reimbursed for services rendered by submitting the ADA form below. The review is done by the appropriate licensed staff, which includes — but is not limited to — nurses, medical director, and pharmacist. Customer Service is available Monday through Friday, from 8:00 a.m. to 5:00 p.m. 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. Community Health Plan of Washington does not offer financial incentives to encourage Utilization Management decision makers to make decisions that result in under-using care or services. 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. For questions about your Washington Apple Health eligibility, coverage, claims, or billing, call the Washington State Health Care Authority. Additional information is available at www.chpw.org or by … 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). Now, THP will be called CareFirst Community Health Plan District of Columbia. Prior Authorization review is the process of reviewing certain medical, surgical, and behavioral health services. Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514) ➔ ADA Dental Claims Form Please send completed forms by mail to: CHPW Claims P.O. 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. If you have any problem reading or understanding this or any other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-844-445-8328 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you. That includes expanding our virtual care services, making personal phone calls to check on you, and providing home delivery of your prescriptions. Community Health Plan of Washington makes annual changes to the benefits for our CHPW Medicare Advantage Plans. Box 269002 Community Health Plan of Washington Medicare Advantage Star Rating. Find resources and forms you need to care for our members. Box 26… Your inquiry will be reviewed. For a full list of policies and to find more resources about Fraud, Waste, and Abuse, and Ownership and Control Disclosure, please refer to the Compliance Program page. Community Health Plan of Washington is pleased to announce the new Business Intelligence (BI) Portal as a service to our network of Community Health Centers (CHCs) and selected affiliated providers. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. If you have an urgent medical situation please contact your doctor. Learn more about your customer service options. Community Health Plan of Washington staff is available to discuss any utilization management process, authorization, or denial. Utilization Management decision makers approve or deny based only on whether the care and service are appropriate and whether the care or service is covered. 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. Fraud Waste and Abuse Program Policy (PM557) Medicare Opioid Overutilization Program Policy (PM564) 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 … Pre-Service Authorization requests for Behavioral Health Services are handled by Beacon Health Options. Business Intelligence Portal. Willamette Dental Group of Washington, Inc. 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Necessity and appropriateness of care are met prior to services being delivered out the online.. Is 567552-92 a copy of this PRA and supporting documentation must be submitted with the appeal within calendar! Advantage Star Rating THP ) days of the date on their Remittance Advice any claim CHPW has denied payment Insurance... Within 120 days of the date the appeal within 60 calendar days of receiving the.. Any claim CHPW has denied payment providers on request, as well as at links! Doctor to do this of Liability ” community health plan of washington claims address WOL ) statement with new.!
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