Provider Newsletter
Our latest Provider Newsletter highlights provider and staff training and the new provider directory.
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Scammers impersonating state regulators
Scammers are targeting health care practitioners in Washington state
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Secondary Option for Claims Submissions
CHPW is offering a secondary option for electronic claims submissions
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2023 Formulary Changes
Our Medicare formularies are updated monthly and last approved date is 10/01/2023
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Health & Housing Toolkit
Resource for community partners who are working to advance health and housing partnerships
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Payment for OTP Services
Medicare is the primary payer for dual-eligible beneficiaries who receive Opioid Treatment Programs services
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CMS PDGM Payment Methodology
Since January 1, 2020, CMS has used PDGM to reimburse home health agencies that provide home health services.
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CMS SNF Payment Model
Read about CMS’s Patient-Driven Payment Model (PDPM), for reimbursing Skilled Nursing Facilities (SNF) stays.
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Medical Records for Post Payment Review
Providers need to provide complete and accurate records timely for post payment review
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Determining New or Established Patients
How to use evaluation and management (E/M) codes for “new patients” vs. “established patients”.
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CAHPS Survey for New Members
New members are receiving Consumer Assessment of Healthcare Providers and Systems survey soon.
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Prior Authorization 2024 Changes
2024 PA List and Utilization Guidelines (effective: Jan 1, 2024)
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Procedure Code Lookup Tool
Our new prior authorization code lookup tool is coming soon, learn more.
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Pharmacy Preferred Newsletter
Our November 2021 Pharmacy Preferred Newsletter is now available.
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Billing and Rendering Taxonomy Requirements
CHPW’s clearinghouse has been rejecting any claims submitted without valid billing and/or rendering taxonomy codes and those claims are not submitted to CHPW.
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SHINGRIX Vaccine
Shingrix Vaccine is recommended in adults age 50 and older.
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Online Provider Search Tool
Learn about the new provider search tool coming in July.
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ERA Enrollment Process
The enrollment process is all electronic and does not require a fee to register or enroll.
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Medicare Programs Innovations
New enriched benefits and reduced cost-sharing for chronic conditions
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Our New Medicare Name
Community HealthFirst Medicare Advantage is now Community Health Plan of Washington Medicare Advantage
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- TALK TO A SPECIALIST
- Click here to schedule a plan review with a Medicare enrollment specialist.
- NURSE ADVICE LINE
- 1-866-418-2920
- (TTY:711)
- CUSTOMER SERVICE
- 1-800-942-0247
- (TTY:711)
- ADDRESS
- 1111 Third Ave
- Suite 400
- Seattle, WA 98101
- HOURS
- 8:00 a.m. to 8:00 p.m.
- Seven Days a Week
QUICK LINKS
- PLANS
- Dual Complete (HMO D-SNP)
- Dual Select (HMO D-SNP)
- Meet a Medicare Specialist
- Compare Plans
- How to enroll?
- Plan Finder
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- Public Health News
- Contact Us
Community Health Plan of Washington is an HMO plan with a Medicare contract and a contract with the Washington State Medicaid program. Enrollment in Community Health Plan of Washington depends on contract renewal. Community Health Plan of Washington complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you need an accommodation, or require documents in another format or language, please call 1-800-942-0247 (711) 8 a.m. to 8 p.m., 7 days a week. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-942-0247 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-942-0247 (711).
Based on a Model of Care review, Community Health Plan of Washington has been approved by the National Committee for Quality Assurance (NCQA) to operate a Special Needs Plan (D-SNP) through 2024.
Limitations, copayments, and restrictions may apply.
You must continue to pay your Medicare Part B premium.
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