Community Health Plan of Washington require prior authorization for the following:
OUTPATIENT AND SPECIALTY SERVICES
- Chiropractic: More than 12 visits for Medicare Advantage and qualifying Washington Apple Health/FIMC patients age 20 and under. See Benefits for more information.
- Hyperbaric oxygen treatment
- ST Therapy: Prior Authorization required for more than 12 visits under Medicare Advantage and for patients age 21 and over needing more than 6 visits. Washington Apple Health/FIMC patients: Submit a Benefit Limit Extension Form.
- PT/OT therapy: PA required for Medicare Advantage and Washington Apple Health/FIMC patients age 20 and under needing more than 12 visits. Washington Apple Health/FIMC patients needing more than 6 visits: Submit a Benefit Limit Extension Form.
- Orthoptic/Pleoptic Training
- Spinal Injections (Washington Apple Health/FIMC)
All admissions, planned and urgent, require notification of admission within 24 hours or next business day. Submit an Inpatient Admission Form
- Planned inpatient services, including surgery
- Inpatient rehabilitation
- Skilled nursing facility
- Administrative Days following denial of inpatient days require prior authorization.
Submitting a prior authorization request
Fax: Fill out the form matching your request listed on the main Prior Authorization page and fax to the number listed on the form.
Please contact CHPW with any questions or concerns.