Community Health Plan of Washington (CHPW) became aware of an error with our 835s (electronic remittance advices, or RA) for check date 8/22/17.You can disregard the 835s that were sent this week. All 835s will be re-generated (replaced) and sent to providers by end of day August 30th.

What happened?

Coordination of benefits (COB) detail is provided on all 835s regarding whether other health insurance was primary or secondary for claims processed. A recent update to that logic in the claims system caused claims with check date 8/22/17 to reflect a COB status of 2, which indicates the claim was processed as secondary in error.

Here are definitions for the main COB status types that we use:

1: Processed as Primary: Use this code if the claim was adjudicated by the current payer as primary regardless of whether any part of the claim was paid.

2: Processed as Secondary: Use this code if the claim was adjudicated by the current payer as secondary regardless of whether any part of the claim was paid.

Has this been fixed?

Yes. The system has been updated as of today (August 29th) to ensure that the 835s generated this week will be correct, in addition to re-running the 835s from last week’s payment cycle.

If you have any questions, please contact:

Washington Apple Health (Medicaid) Customer Service, (800) 440-1561

Fully Integrated Managed Care (FIMC) Customer Service, (866) 418-1009

Community HealthFirst™ (Medicare) Customer Service, (800) 942-0247