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. Willamette Dental Group of Washington, Inc. 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Hospital Admission Patient Management (UM211) 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. All requests are subject to current benefits and coverage limitations. Please note, CHPW processes dental claims for Medicare members only. All guidelines are reviewed at a minimum of once every two years. 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. Please take a few minutes to complete a brief survey about our providers. 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. Providers can be reimbursed for services rendered by submitting the ADA form below. See a list of important phone numbers and contact information for Kaiser Permanente. Emergency Fill Policy (PM516) 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. 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A Increase font size. They are approved based on standards that protect patient safety. You will need Adobe reader to open PDFs on the site. MA Pharmacy Plan 009 Interested? Requests for appeals that do not include a WOL will be dismissed. The deadline is every Tuesday at 5 p.m. for payment the following Monday. Training courses are available on the CMS Medicare Learning Network website. The guidelines also ensure that the criteria used for utilization management decisions are current. Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…. CHPW is committed to Washington's health. Box 26… Providers can be reimbursed for services rendered by submitting the ADA form below. Requests for payment appeals must be filed within 60 calendar days of receiving the PRA. To see the changes effective January 1, 2020, please review the Annual Notice of Changes (ANOC) for all of our 2020 plan options.. 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. That includes expanding our virtual care services, making personal phone calls to check on you, and providing home delivery of your prescriptions. Business Profile ... Community Health Plan of Washington. CHPW must make a decision regarding the payment dispute within 30 calendar days from the date the payment dispute is received. CHPW covers members for 100% of billed charges for preventive and up to the benefit amount for comprehensive services. Claims for Medicaid members should be sent to Provider One. If you have a life threatening emergency, please contact 911. If you have any questions about filling out and submitting online or paper forms, please contact Customer Service for assistance. All clinic staff – including CEOs, senior leaders, managers, clerical/admin staff, physicians, and other clinical staff – are required to receive this training. We follow these rules: Community Health Plan of Washington is committed to keeping up with new technologies. 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. READ MORE. 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 need hard copies of any of our materials, contact your Provider Relations Representative. Requests for payment appeals must include a completed and signed “Waiver of Liability” (WOL) statement. Please submit your Review and or Payment Dispute to: Community Health Plan of Washington Important! Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514) 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. A copy of this PRA and supporting documentation must be submitted with the appeal request. The company's filing status is listed as Inactive and its File Number is 567552-92. Authorization and Certification Policy (UM203) 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. P.O. Community Health Plan of Washington. You can submit a request for a coverage determination review by sending in a Coverage Determination Request form or filling out the online form. Fraud Waste and Abuse Program Policy (PM557) We also look at medical standards. MA Pharmacy Plan 008 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 use information from your doctor to do this. Paper copies of the guidelines are available for members or providers on request, as well as at the links provided. Find resources and forms you need to care for our members. Payment denials may be appealed as described in the Non-Contracted Provider Appeal section above. If you have questions, call Customer Service for help. These language assistance cards are available for CHPW members to download, print, and carry in their wallet. Call 1-866-686-9323, TTY 711. This means we review new tests, drugs, treatments, and devices and new ways to use current tests, drugs, treatments, and devices. STAR Kids Program: 1-855-607-7827 The Clinical Quality Improvement Committee (CQIC), which includes medical and behavioral health providers and quality specialists, participates in this review and approves any changes. STAR Program: 1-800-434-2347. Customer Service is available Monday through Friday, from 8:00 a.m. to 5:00 p.m. 1111 3rd Ave. Ste 400. Coverage Determinations and Exceptions Policy (PM554) CHPW Claims Member Benefit grids act as a reference guide and not a guarantee of coverage. Current policies that you need to care for members can be found below. All of our providers must be compliant with state and federal regulations. www.RadMd.com or (888) 899-7804. The data exchange with the state financial office occurs on Thursdays and Fridays. Please fill out the below form or contact us at 1-877-600-5472 (TTY/TDD: 711). Pharmacy Review of Coverage Redeterminations (PM555) ➔ ADA Dental Claims Form Please send completed forms by mail to: CHPW Claims P.O. Seattle, WA 98101. This is to ensure the medical necessity and appropriateness of care are met prior to services being delivered. 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. The non-contracted provider payment dispute process can not be used to challenge payment denials that result in zero payment. 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). It's for people who meet income requirements and are eligible for Washington Apple Health (Medicaid) Integrated Managed Care. ➔ Download the current Clinical Practice Guidelines. ➔ Download the Coverage Determination Request Form, ➔ Complete your Coverage Determination Request online. 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. Additional information is available at www.chpw.org or by … Claim Share Print. A Reset font size. MA Plan 006 You must ask for a fair hearing within 120 days of the date on the health plan’s letter with a decision. 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. Providers and Locations. Effective October 1, 2016, HCA will accept only electronic claims for Apple Health (Medicaid) services, except under limited circumstances. Community Care Plan serves the health of our community through access to a high standard of health care and community resources. (855) 481-7041. More information can be found in our Provider Manual. Business Profile. Download the free version on Adobe Reader. 1111 Third Avenue, Suite 400 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). TALK TO AN EXPERT; Click here to schedule a plan review. resource for the process of billing and submitting claims to the Washington Health Care Authority (HCA). 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: You can search for a variety of health care providers: primary care doctors, specialists, mental health or substance use disorder treatment providers. Community Health Network of Washington Cascade Select is a health insurance plan for individuals and families offered by Community Health Network of Washington (“CHNW”). And community resources the appeal required to complete a brief survey about our.. 1-855-923-4633 ) TTY/TTD 1-855-627-9604 to choose UnitedHealthcare community Plan we can help 5:00 p.m are! Technology requests for payment appeals must be compliant with state and federal.. To: CHPW claims P.O of each Managed care Plan under Apple Health eligibility coverage! In community Health Plan of Washington does not reward providers or others for denying or. 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