community health plan of washington claims address

Emergency Fill Policy (PM516) Now, THP will be called CareFirst Community Health Plan District of Columbia. 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. We follow these rules: Community Health Plan of Washington is committed to keeping up with new technologies. Find resources and forms you need to care for our members. 1111 3rd Ave. Ste 400. Washington Apple Health (Medicaid) Integrated Managed Care (IMC) Our plan offers a range of physical and behavioral health benefits. Providers can be reimbursed for services rendered by submitting the ADA form below. Claim Share Print. 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. Claims for Medicaid members should be sent to Provider One. See a list of important phone numbers and contact information for Kaiser Permanente. 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 (CHPW) were founded in 1992 by Washington’s community health centers. Paper Claims Submission Practices Changing The Clinical Quality Improvement Committee (CQIC), which includes medical and behavioral health providers and quality specialists, participates in this review and approves any changes. (855) 481-7041. Hospital Admission Patient Management (UM211) Authorization and Certification Policy (UM203) ➔ ADA Dental Claims Form Please send completed forms by mail to: CHPW Claims P.O. Interested? All clinic staff – including CEOs, senior leaders, managers, clerical/admin staff, physicians, and other clinical staff – are required to receive this training. They are approved based on standards that protect patient safety. Payment denials may be appealed as described in the Non-Contracted Provider Appeal section above. Box 26… Pricing Policy (Default, By Report, and Non-Covered Codes) (OP647) 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). Non-Contracted Providers: In accordance with Medicare Managed Care guidance, non-contracted providers have payment dispute rights. 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. You must ask for a fair hearing within 120 days of the date on the health plan’s letter with a decision. MA Plan 006 Paper copies of the guidelines are available for members or providers on request, as well as at the links provided. A Reset font size. 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. If you have a life threatening emergency, please contact 911. Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514) Plano, TX, 75026. CHPW is committed to Washington's health. Each health plan has its own network of providers, hospitals, and pharmacies. If you have questions, call Customer Service for help. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. A Decrease font size. 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. Providers and Locations. Enrollment in Community Health Plan of Washington Medicare Advantage Plan depends on contract renewal. Community Health Plan Of Washington is an Oregon Domestic Non-Profit Corporation filed on January 9, 2009. ©2020 Community Health Plan of Washington, Phone: 1-800-944-1247 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. A copy of this PRA and supporting documentation must be submitted with the appeal request. We also look at medical standards. This means we review new tests, drugs, treatments, and devices and new ways to use current tests, drugs, treatments, and devices. We look forward to continuing service to our 35,000 enrollees in the District. This is to ensure the medical necessity and appropriateness of care are met prior to services being delivered. Home › Provider Center › Provider Resources. A Trillium Community Health Plan representative may contact you regarding your inquiry. Seattle, WA 98101. Community Health Plan of Washington makes certain policies and procedures available to providers. Reference our care guidelines and other information for providers. Reference is made to the pertinent evidence-based, peer-reviewed guidelines from Nationally recognized agencies. 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. Current policies that you need to care for members can be found below. 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 : [email protected] Phone : 206-652-7178 Claims may be submitted to : CHPW Claims P.O. ➔ Download the current Clinical Practice Guidelines. Willamette Dental Group of Washington, Inc. 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Coverage Determinations and Exceptions Policy (PM554) Premiums Disclaimer: You must continue to pay your Medicare Part B premium. 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 … READ MORE. New technologies are evaluated on an ongoing basis. Box 269002 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. Training courses are available on the CMS Medicare Learning Network website. If you have an urgent medical situation please contact your doctor. The review is done by the appropriate licensed staff, which includes — but is not limited to — nurses, medical director, and pharmacist. Providers are required to complete a Fraud, Waste, and Abuse training within 90 days of contracting with CHPW and annually thereafter. MA Extra Plan 010 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. CHPW must make a decision regarding the appeal within 60 calendar days from the date the appeal request is received. 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. All guidelines are reviewed at a minimum of once every two years. More information can be found in our Provider Manual. Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…. Community Health Plan of Washington Medicare Advantage Star Rating. You will need Adobe reader to open PDFs on the site. The company's filing status is listed as Inactive and its File Number is 567552-92. TALK TO AN EXPERT; Click here to schedule a plan review. Note: The vision benefit continues to be administered through Vision Service Plan (VSP), offering our members a number of options to … Please fill out the below form or contact us at 1-877-600-5472 (TTY/TDD: 711). ProviderOne claims submission deadlines. Your comments help us improve the quality of our programs and services. CHPW Claims Community Health Network of Washington Cascade Select is a health insurance plan for individuals and families offered by Community Health Network of Washington (“CHNW”). For questions about your Washington Apple Health eligibility, coverage, claims, or billing, call the Washington State Health Care Authority. 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. The IRE will review the appeal and notify the provider in writing of the decision. You can search for a variety of health care providers: primary care doctors, specialists, mental health or substance use disorder treatment providers. CHPW covers members for 100% of billed charges for preventive and up to the benefit amount for comprehensive services. 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. Utilization management is a process of reviewing whether care is medically necessary and appropriate for patients. Download the free version on Adobe Reader. ➔ Download the Coverage Determination Request Form, ➔ Complete your Coverage Determination Request online. Pre-Service Authorization requests for Behavioral Health Services are handled by Beacon Health Options. These language assistance cards are available for CHPW members to download, print, and carry in their wallet. If you disagree with the health plan’s decision to cover something, you can ask your health plan for a fair hearing. All requests are subject to current benefits and coverage limitations. Medicare Opioid Overutilization Program Policy (PM564) The guidelines also ensure that the criteria used for utilization management decisions are current. 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 does not offer financial incentives to encourage Utilization Management decision makers to make decisions that result in under-using care or services. Community Care Plan serves the health of our community through access to a high standard of health care and community resources. Pharmacy Review of Coverage Redeterminations (PM555) If you have any questions about filling out and submitting online or paper forms, please contact Customer Service for assistance. 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 Pharmaceutical Patient Safety Policy (PM509) If you have contracting questions, please contact: [email protected]. 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. STAR Program: 1-800-434-2347. You can submit a request for a coverage determination review by sending in a Coverage Determination Request form or filling out the online form. 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. The non-contracted provider payment dispute process can not be used to challenge payment denials that result in zero payment. 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. 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. Members denied a service or referral have the right to submit an appeal. 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. 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. Providers can be reimbursed for services rendered by submitting the ADA form below. Hospice Care, Pediatric Concurrent Care, and Pediatric Palliative Care Policy (MM163) All of our providers must be compliant with state and federal regulations. CHPW cannot begin the appeals process without a signed WOL. Community Health Plan of Washington is an HMO plan with a Medicare contract. Benefit Disclaimer: Limitations, copayments, and restrictions may apply. MA Value Plan 016. If you need hard copies of any of our materials, contact your Provider Relations Representative. Please verify with the health plan that the providers you prefer are in the plan’s network. Community Health Plan of Washington makes annual changes to the benefits for our CHPW Medicare Advantage Plans. Community Health Plan of Washington staff and providers determine whether services are approved or denied. If a service or treatment is not listed in the member benefit grid, refer to the appropriate prior authorization category for more information. P.O. The data exchange with the state financial office occurs on Thursdays and Fridays. This is not a complete description of benefits, please contact us for more information. STAR Kids Program: 1-855-607-7827 Learn more about your customer service options. Appeal rights apply to any claim CHPW has denied payment. Community Health Plan Of Washington was founded in 1996, and is located at 1111 3rd Ave Ste 400 in Seattle. CHPW covers members for 100% of billed charges for preventive and up to the benefit amount for comprehensive services. We use information from your doctor to do this. Benefit Limitation Extension Policy (UM428) 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. View the benefits below to see all that it offers. Please note, CHPW processes dental claims for Medicare members only. The Registered Agent on file for this company is Paychex, Inc. and is located … 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. 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. Requests for appeals that do not include a WOL will be dismissed. Customer Service is available Monday through Friday, from 8:00 a.m. to 5:00 p.m. Business Intelligence Portal. 1111 Third Avenue, Suite 400 View the Washington Apple Health Plan Report Card for plan comparisons of each managed care plan under Apple Health. Health Insurance. We handle new technology requests for a specific member in a timely manner. 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. Box 269002 Plano, Tx 75026-9002 Community Health Plan of Washington. Providers may see a Friday date on their Remittance Advice. 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 . They are processed as prior authorization requests. Please take a few minutes to complete a brief survey about our providers. Copyright Requests for payment appeals must be filed within 60 calendar days of receiving the PRA. Requests for payment disputes must be filed within 120 calendar days of the PRA. 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 Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. Pre-Service Authorization requests for certain non-emergent imaging services are handled by National Imaging Associates (NIA). In January 2020, CareFirst BlueCross BlueShield announced the acquisition of Trusted Health Plan (District of Columbia), Inc. (THP). Transition Process Policy – MA (PM553). Important! 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