Community Health Plan of Washington requires prior authorization for the following:

Radiology

  • MRI/MRA
  • Dual X-ray Absorptiometry (Washington Apple Health/FIMC)
  • Proton Beam Radiation Therapy (Washington Apple Health/FIMC)
  • Intensity Modulate Radiation Therapy (Washington Apple Health/FIMC)

Surgical Procedures

  • All planned Inpatient procedures
  • Bariatric surgery (additional forms may be required, found here)
  • Cochlear implant
  • Endovenous laser/Radiofrequency ablation
  • Facet Neurotomy
  • Hysterectomy (additional forms may be required, found here)
  • Mammoplasty (Augmentation/Reduction)
  • Reconstructive plastic surgery & supplies
  • Rhinoplasty and septoplasty
  • Sclerotherapy, leg veins
  • Spinal surgeries
  • Shoulder Arthroscopy
  • Knee Arthroscopy
  • Cardiac Stents (Washington Apple Health/FIMC)
  • Tympanostomy Tubes (16 and under) (Washington Apple Health/FIMC)
  • Spinal Injections (Washington Apple Health/FIMC)
  • Extracorporeal Membrane Oxygenation (Washington Apple Health/FIMC)

Transplants

  • Organ donation (living)
  • Transplants (excluding corneal)
  • Evaluation/Work-up

Submitting a prior authorization request

ONLINE (preferred): through the Care Management Portal
Request a Care Management Portal account to check eligibility and authorization status, print approval  letters, and submit requests online 24/7.

Fax: Fill out the form matching your request listed on the main Prior Authorization page and fax to the number listed on the form
Prior Authorization Request Forms (PDF)

Please contact CHPW with any questions or concerns.