- Browse 2019 Tier One Formulary
- Browse 2019 Tier Five Formulary
- Formulary Exception / Medicare Part D Coverage Determination Request Form
- Drug Recall Report
Access online portals that allow you to easily submit and track prior authorizations, claims, member information, and more.
Payment Dispute Information
- Appeal and Payment Dispute Rights
- Payment Guide for Out of Network Payments
- Waiver of Liability Statement
All of our providers need to be compliant with state and federal regulations. To find resources about Fraud, Waste, and Abuse, and Ownership and Control Disclosure, please visit https://www.chpw.org/for-providers/documents-and-tools/.
Special Needs Plan: Transition of Care
Community Health Plan of Washington is committed to managing the transition of all SNP members from one care setting to the next, and back to their medical homes. This process will necessitate activities for us and the attending caretaker(s) at each service facility. Please review and familiarize yourself with the following minimal expectations required to be completed whenever there is an SNP member planned or unplanned inpatient or discharge event.
They include but are not limited to:
- A discharge summary
- Medication list review with the member
- Review of any required follow-on appointments
If you have questions regarding Community HealthFirst Medicare Advantage Plans or Policies, please contact your Community Health Plan Provider Relations Representative.
Policies and Procedures
Community Health Plan of Washington makes certain policies and procedures available to providers. To view our policies, please visit: https://www.chpw.org/for-providers/other-resources/policies or contact your Provider Relations Representative.