As a CHPW provider, we support you in caring for our members – your patients. Find answers to questions you may have about our provider portals, accessing training and orientation materials and more. 

Providers Frequently Asked Questions

How can I become a Community Health Plan of Washington Provider?
To join our network, please fill out and submit an online Provider Enrollment form. We will review your information and contact you within 30 days regarding your request. If you have questions, please contact our Provider Relations department at Provider.Relations@chpw.org  
How do I register for the HealthMAPS portal?

Register for HealthMAPS here You need your Billing Tax ID number(s) to register. It may take up to 10 calendar days for your registration to process. You will receive an email when your registration is complete.

How do I know if a drug I prescribe is on the formulary?

You can review the formulary lists to identify what drugs are covered by CHPW and which require pre-authorization. Drugs not listed on our formulary require prior authorization. You can submit prior authorization requests through our care management portal (JIVA.) For self-administered drugs requiring prior authorization, please contact Express Scripts at 1-844-605-8168 or use https://www.CoverMyMeds.com to start the prior authorization process.

Who do I contact for claim status, prior authorization, member benefits or member eligibility?

Providers can get in touch with their Provider Relations Representative or contact customer service for assistance at 1-800-942-0247.

I have a patient that missed their appointment without warning. Can I still bill them?

No. Patients cannot be billed for missed appointments. Make sure they are aware of your clinic’s cancellation or late appointment courtesy policies.

My patient needs to see an out-of-network specialist. Can I still refer them?

Out-of-network specialists require prior authorization and must meet certain criteria, for example, if there is not a similar in-network provider who can perform the same service. Submit a prior authorization request to get started.

 

If you still have questions, call Customer Service for help. There are available from 8:00 a.m. to 8:00 p.m., seven days a week at 1-800-942-0247.

DID YOU KNOW...?

Provider Education and Training

Laughing Female Doctor at Desk in OfficeCHPW provides the resources you need to best care for members and stay compliant with local and federal regulations. Some training programs are optional and others are mandatory.

All CHPW contracted providers and clinic staff must complete the following: Model of Care Training, Patient Rights and Responsibilities & Advance Directives Training, and CMS Fraud, Waste, and Abuse Training.

Learn more about required training in the provider manual.

☏ HAVE QUESTIONS ?

Sales Team

Get real answers
from real people

Phone: 1-800-944-1247
Email: Sales@chpw.org

x