Online Forms for Children First

Great news! CHPW has improved the redemption process for our popular Children First rewards program to make it easier for providers. This includes both the Well Child and Prenatal program rewards. We now offer a 100% online method of submitting rewards claims for your patients—no provider signature required. Just visit our Forms and Tools page and select the Well Child or Prenatal online form to get started.

Please note that we still offer the downloadable paper forms, but we recommend you use the new online process. Not only is it faster and easier, it instantly checks our system to confirm your patient is eligible for a reward.

If you aren’t familiar with the Children First reward program and would like to learn more, contact your CHPW Account Executive.

 
 

Sports Physicals

CHPW continues to look for new opportunities to increase value to our members, differentiate ourselves from other MCOs in the marketplace, and grow Apple Health enrollment. Last summer, CHPW launched 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. This may help to improve adolescent access to care and well-care visit rates.

 
 

Provider and Staff Training Programs

CHPW is committed to provide training and education to our Providers and their Staff. We are dedicated to develop your knowledge and understanding through a variety of mandatory and optional training programs.

To access our on-line training programs, go to our website at www.chpw.org. From the home page, select “For Providers” and from the menu, select Orientation, Training and Education.

If you prefer an in-person training session, or if you have any questions regarding our training programs, please contact our Provider Relations Administrator, Carmen Switzer at Carmen.Switzer@chpw.org or 206 613-8827.


Thank You for Joining Us

On behalf of CHPW’s Provider Relations team, we want to thank the providers and staff who attended our Annual CHPW Workshop this year! The primary goal of our annual Workshop is to bring you information and updates to assist you with your day to day operations. We hope the Workshop was informative, worthwhile and fun for you! If you should have any questions or need assistance, please feel free to contact our Provider Relations team anytime. You can contact your Provider Relations Administrator or Representative directly or email Provider.Relations@chpw.org.

We wish our valued providers and staff a fun and safe summer!


Pharmacy Prior Authorizations

Last year, Express Scripts partnered with CoverMyMeds to provide electronic prior authorization (PA) submission. Some features of CoverMyMeds are PA renewal reminders and an address book that stores and auto-fills all contact information. Visit CoverMyMeds to sign up!

 
 

Remittance Advices (RAs)

If you currently receive paper RAs, we encourage you to sign up for electronic remittance advices (ERAs)/835s. If you sign up for 835s, or if you currently receive paper and electronic RAs, we will automatically turn off your paper RAs within 90 days unless you contact us and ask us not to.

Please contact edi.support@chpw.org with questions about any of the electronic transactions that CHPW supports.

 

Makena/17P Service

The Optum OB RN Home Administration Service is the preferred delivery method for Makena/17P. The prescription will be filled by Accredo to be shipped to the patient’s home. Optum will contact both the physician and patient to initiate home administration. Benefits of this process include timely start of care and decreased risks of PTB and SPTB. Optum will soon be visiting clinics to answer any questions.

 
 

Multicultural Health Care

CHPW is committed to meeting the linguistic and cultural needs of our diverse members because we recognize that both play an important role in health care outcomes. We are striving to reduce health disparities by working to obtain NCQA’s Multicultural Health Care distinction award. To achieve these goals, we must know as much as possible about our members’ needs.

CHPW is committed to meeting the linguistic and cultural needs of our diverse members because we recognize that both play an important role in health care outcomes. We are striving to reduce health disparities by working to obtain NCQA’s Multicultural Health Care distinction award. To achieve these goals, we must know as much as possible about our members’ needs.

In addition to knowing about our members, we need to know about you – our providers. CHPW will begin asking you to supply your race, ethnicity, and language information during annual updates to your provider information. This data will be used to ensure that we are prepared to meet the cultural needs of our members.

To be proactive, please consider sending updated demographic data to Provider.Changes@chpw.org. Demographic data may be submitted via your physician rosters or by filling out the Provider Add Change Term form, which can be found at this link.

 
 

Telehealth Services (Telemedicine)

CHPW follows the Apple Health provider guidance and related WAC 182-531-1730 and CMS guidelines. The limitations are the same for any provider providing telemedicine services. The provider must be operating within the scope of their license; they must be at an approved originating site, and using HIPAA compliant, interactive, real-time audio and video telecommunications (including web-based applications) or store and forward technology. The services must be covered services that are within the scope of the provider’s license. Additional limitations apply for drug monitoring. Please see the HCA’s Physician-Related Services/Health Care Professional Services Billing Guide (physical health services) or Mental Health Services Billing Guide (includes drug monitoring) for more information.

Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014.

Eligible originating sites:

  • Clinics 
  • Community mental health/chemical dependency settings 
  • Dental offices 
  • Federally qualified health center (FQHC) 
  • Home or any location determined appropriate by the individual receiving service 
  • Hospitals (inpatient and outpatient) 
  • Neurodevelopmental centers 
  • Physician or other health professional’s office 
  • Rural health clinics (RHC) 
  • Schools 
  • Skilled nursing facilities

If a provider from the originating site performs a separately identifiable service for the client on the same day as telemedicine, documentation for both services must be clearly and separately identified in the client’s medical record.

Distant site:

The payment amount for the professional service provided through telemedicine by the provider at the distant site is equal to the current fee schedule amount for the service provided.

Use the appropriate CPT codes with modifier GT or modifier 95 (via interactive audio and video telecommunications system) when submitting claims to the agency for payment. Both of these modifiers are acceptable to indicate synchronized telecommunication.

Effective January 1, 2017, a new point of service (POS) code 02 has been created for physicians or practitioners providing Telehealth services from a distant site. The POS 02 code is the location where health services are provided through telecommunication technology. The POS 02 code does not apply to the originating site.

Modifiers GT, GQ, and 95 are required when billing POS 02. Please make sure to bill Telehealth services correctly, using POS code 02 and the GT, GQ, or 95 modifiers, to avoid claim payment delays.

If you have questions, you can:

  • Call Apple Health Customer Service, (800) 440-1561
  • Call Medicare Customer Service, (800) 942-0247
  • Email cs.claimsdistribution@chpw.org (for Apple Health or Medicare)

Submitting Corrected Claims Electronically

Corrected Claims.

A corrected claim is one that was previously billed and processed but needs to be reprocessed with corrected information (such as date of service, patient information, procedure codes, etc.). CHPW encourages our providers to submit corrected claims electronically, rather than on paper; paper is needed only when the corrected claim requires an attachment. At this time, we are not able to accept attachments with electronic claims.

CHPW recently reviewed a sample of paper corrected claims from 2016, based on the following criteria:

  • Original Claim Submission – Electronic
  • Corrected Claim Submission – Paper
  • Attachment – Corrected Claim Cover Sheet (only) = 59.95%

We found that for original claims submitted electronically with a corrected claim submitted via paper, nearly 60% out of a sample of just over 300 claims had no attachment other than a cover sheet.

How to Submit Electronic Corrected Claims

When submitting a corrected claim to CHPW electronically, please use the replacement code. In Loop 2300 (Claim Information), segment CLM05-3, use Claim Frequency Type Code “7” for “Replacement.” The corrected claim will process as a replacement claim and reverse the original claim on file.

Corrected Claim Timelines

Medicare Advantage: CHPW must receive the claim within 1 year from the initial process date. Medicaid (Apple Health): CHPW must receive the claim within 2 years from the DOS

More Information

Please see our Provider Manual for more information about corrected claims and electronic transactions.


Get Ready for New Medicare Cards

Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative, the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private health care and financial information of our Medicare beneficiaries.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. We’ll start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

Click here for more details.

 
 

Provider Data and Provider Directory Quality Assurance

CHPW is committed to maintaining accurate information in our provider directories. Per 42 C.F.R. §422.111, CHPW must provide clear and accurate information to beneficiaries regarding our provider network. Accordingly, the Centers for Medicare & Medicaid Services (CMS) hold CHPW responsible for the accuracy of our provider data.

CMS recently audited the directories of 54 plans and found consistent errors among the plans. CHPW has started a Provider Directory Quality Assurance initiative to review 100% of our contracted providers annually to ensure accuracy.

As a reminder, it is important for providers to notify CHPW timely of provider changes, including:

  • Staffing changes at clinics and facilities
  • Facility relocations and clinic moves
  • Contact information (address, phone number, fax number, website)
  • Practicing locations for each provider
  • Provider terminations

If you are contracted with CHPW and accepting new patients, you will be advertised in our provider directory unless you ask us to exclude you.

Please send any provider updates or requests to be removed from the Provider Directory to Provider.Changes@chpw.org.

Current provider information helps us keep provider rosters up to date, ensure accurate and timely claims payment, in addition to keeping our provider directory current for our membership.

 
 

New Credentialing Requirement for ABA Providers

Effective July 1, 2017, The Health Care Authority requires all Applied Behavior Analysis (ABA) providers to be licensed or certified by the Department of Health (DOH) under WAC 246-805. The following new DOH credentials have been created in compliance with WAC 246-805:

  • Licensed Behavior Analyst or “LBA”
  • Licensed Assistant Behavior Analyst or “LABA”
  • Certified Behavior Technician or “CBT”

Any provider with the above new DOH credentials must be issued a license by the DOH prior to requesting initial credentialing with CHPW. Providers who are currently credentialed, please email a copy of the new license to provider.credentialing@chpw.org. Additional information about the credentials requirements can be found on the DOH website.

Single Preferred Drug List in 2018

SB 5883 was passed on June 30, 2017 mandating that all MCOs and WA FFS utilize a single preferred drug list (PDL) on or before January 1, 2018. The single PDL will ensure continuity of formulary and criteria for coverage across all MCOs and FFS.

The goal is to ensure access to clinically effective and appropriate drug therapies while maximizing rebates to the state. CHPW pharmacy is working with the HCA in the development of both the future PDL and the criteria for coverage. The HCA is developing a communication strategy to update providers and pharmacies of changes as they roll out. CHPW will also be alerting you to upcoming changes as they are finalized.