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  •
    Mandatory Modifiers on Medicare Claims
    We'd like to remind you that Medicare claims submitted without the correct modifiers will be rejected and will have to be resubmitted. CHPW will have a new claim edit in place as of 9/18/2017.
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  • Pre-Authorization Affected by Hurricane Irma
    Due to Hurricane Irma's impact on the Tampa Bay region, our ability to process pre-authorization and utilization requests has been affected.
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  • Hurricane Irma may Impact CHPW’s Service Capacity
    Some of CHPW care management team members are located in the path of Hurricane Irma. This may affect our capacity to respond to provider requests.
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  • Second Error on Recent 835s
    We discovered there were still claim records with the incorrect COB status code. The 835's from 8/22 and 8/29 have been regenerated and were posted 9/1/2017. Our sincerest apologies for any confusion this week.
  • Provider Newsletter
    Read our latest Provider Newsletter! The July edition contains information about Sports Physicals, online sign-up for Children First rewards program, training programs, telemedicine, and more!
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  • New HCA Opioid Policy
    A new clinical policy pertaining to opioid prescriptions takes effect for Apple Health on Nov. 1, 2017
    Read more >>
  • Register for Opioid Policy Webinar
    The HCA will host a one-hour webinar on their new opioid policy on two different dates. Registration is now open.
    Register now >>
  • Error on Recent 835s
    CHPW became aware of an error with our 835s for check date 8/27/2017. Please disregard the 835s that were sent initially. You should have received new 835s by 8/30
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  • Telehealth Services
    More patients are interested in telemedicine. See rules and guidelines for this service from CMS and the HCA.
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  • Standard Formulary in 2018
    Beginning in 2018, all Washington managed care organizations and fee-for-service will use a single formulary.
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  • How to get ready for new Medicare cards
    CMS will begin replacing current Medicare cards with cards that are more secure. Here are five ways to get your office ready for the change.
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  • HCA Changes to Interpreter Services
    The Health Care Authority (HCA) Interpreter Services Program is changing rates paid and reimbursed for language services provided to Apple Health clients. These changes take effect July 1, 2017.
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  • Medically Intensive Children’s Program (MICP)
    The Medically Intensive Children’s Program (MICP) provides skilled nursing services to children ages 17 and younger. These children have complex medical needs that require a registered nurse to provide support.
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  • Payment Calculation Update
    Community Health Plan of Washington (CHPW) is updating the grouper and weights used to calculate payments for Medicaid outpatient hospital services.
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  • Annual CHPW Workshop Invitations
    We are holding informational workshops for hospital and clinic staff throughout the month of May. Use our invitations to register now! You can register online, or return your registration via email or fax.
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  • Discount for CDR Participation
    Some providers may qualify for a $600 discount to help them meet the criteria for Clinical Data Repository participation.
    Read More >>
  • CDR Information
    Use our checklist to see if you are required to submit to the Clinical Data Repository.
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  • DSC Editor Update
    We are updating our data sensitive code for Medicare inpatient services.
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  • Billing Single Dose Vials
    Washington State Health Care Authority has updated the Billing for Single-Dose Vial guide with examples.
    Read More >>
  • Pricing Methodology Resource
    If you would like to learn more about EAPG and APR-DRG pricing, please click through to our new resource or email cs.claimsdistribution@chpw.org.
    Read More >>
  • Understanding Dosage-Based Assessment
    Make sure you understand how to complete the Dosage-Based Assessment process and include it with your claims. DBA helps ensure children under the age of 19 can receive vaccinations regardless of insurance status.
    Read More >>
  • Upgrade to Claims Editing System
    We have upgraded our claims system to ensure the most current coding, accuracy of processed claims, and more.
    Read More >>
  • 45 Days until CDR Launch
    The clinical data repository will launch on February 1, 2017. Read more to see if you are required to submit information to the Washington State Health Care Authority and OneHealthPort.
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  • 2017 Prior Authorization Lists
    Prior authorization information for 2017 is now available. This includes the prior authorization list, summary of changes, and code look up for Apple Health and FIMC.
    Go to lists >>
  • University of Washington pushes collaboration for mental health care
    The UW Department of Psychiatry is focusing on increasing effective treatment in primary care through collaboration and increased access to psychiatric expertise.
    Read More >>
  • Care Management Referral Programs
    As a provider, you play a critical role in connecting your patients with programs that help them manage medical issues. Read an overview of the care management programs we offer.
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  • HCA changes to Apple Health
    Starting January 1, 2017, the Health Care Authority will change the process for managing Apple Health benefits for clients with other primary health insurance.
    Read More >>
  • Requirement Clarification
    The Health Care Authority has released a statement clarifying the Electronic Health System requirements, Clinical Data Repository requirements, and fees.
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  • Benefit Reminder
    Providers, remember that we offer coverage for emergency contraceptives, long-acting contraception, and smoking cessation.
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  • Flu Season Updates
    There are updates and changes to vaccine coverage for the upcoming flu season.
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  • Core Provider Agreement
    The Washington State Health Care Authority has recently updated their implementation date.
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  • Partnership Access Line (PAL)
    The telephone-based child mental health consultation system is available to connect your patient with mental health resources regardless of insurance.
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  • Update to Timely Filing Terms
    We've updated our Provider Manual to clarify the Timely Filing Requirements for Medicare Advantage claims and Washington Apple Health claims.
    Read More >>
  • Behavioral Health Fact Sheet
    Beginning April 1, 2016, the early adopter region of Southwest Washington (Clark and Skamania counties) was the first to adopt fully integrated managed care, combining coverage for physical and behavioral health services (mental health and substance use disorder) for Apple Health (Medicaid) clients.
    Read More >> >>
  • Change Regarding Sterilization Consent Form
    As a follow up to a recent Provider Alert from the Washington State Health Care Authority (agency): As of July 15, 2016, the agency will no longer accept the discontinued HCA 13-364 form for processing sterilization claims.
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  • Sports Physical Billing
    CHPW has added a new value-added benefit that covers annual sports physical exams for Apple Health kids age 6 -18 at no cost to the member. When possible, we encourage you to schedule a well-care visit with the sports physical exam.
    Read More >>
  • Podiatry Benefit Change
    Effective immediately, specific Bunion procedures will no longer be included as covered benefits. Read more to find out which CPT codes will now be listed as non-covered.
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  • Health Information Portal Updates
    We are pleased to announce recent enhancements to our Health Information Portal.
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  • Retroactive Enrollment
    Beginning April 1, 2016, the Health Care Authority will be implementing retroactive enrollment.
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