We’re here to make the billing process easy.
At Community Health Plan of Washington (CHPW), we aim to make it easy for you to find the billing information you need. Use the resources on this page to manage your practice’s billing, or see our Provider Manual for more information.
Please note that you can submit electronic or paper claims.
CHPW accepts electronic claims via the Availity Clearinghouse. More information is available in our Provider Manual, or you can contact Availity at (800) 282-4548. Please use CHPW’s Payer Identifier: CHPWA.
Paper claims should be sent to the address below. This includes professional, facility, and behavioral health claims for all CHPW benefit plans.
PO Box 269002
Plano, Texas 75026-9002
Please note this address is for paper claims. Other items, such as appeals, should be sent to their specific address.
Secondary billing submission option
In an effort to minimize the recent challenges with electronic claims submissions, CHPW is offering a secondary submission option.
Smart Data Solutions, a CHPW partner, will provide the following solutions:
- Immediate Claim Submission
- Portal Applications for Eligibility and Claim Status
- EMR Connection and Integration
Smart Data Solutions Registration:
If you have any questions, please contact [email protected]
Balance Billing Training
We recommend newly contracted providers complete balance billing training within 90 days of their contract effective date.
Launch Balance Billing Training ➜
After completing the training you must also complete an attestation.
Billing Guidelines
CHPW billing guidelines may change over time. Below is the most recent guidance in alphabetical order.
*Click to see billing guidelines
Alternative Treatments Billing Guidelines
CHPW is proud to offer alternative services for our Apple Health, Individual & Family Cascade Select, and Medicare Advantage members. Our Apple Health and Medicare Advantage members have an open network; providers don’t have to be in our network. Our Individual & Family Cascade Select members must receive their covered acupuncture and chiropractic services from an in-network provider.
Note that the benefits, codes, and billing requirements are different depending on the member’s specific plan. See below for our Alternative Treatments Billing Guidelines.
Read more about alternative treatment billing for Apple Health, Individual & Family Cascade Select, and Medicare Advantage.
Apple Health Dental Services
Billing and Rendering Taxonomy Requirements
CHPW would like to remind all clinics and providers that claims must be billed with valid, appropriate taxonomy codes for the billing provider and, when applicable, the rendering provider.
CHPW’s clearinghouse has been rejecting any claims submitted without valid billing and/or rendering taxonomy codes and those claims are not submitted to CHPW.
Circumcision — Apple Health (Medicaid)
Community Health Plan of Washington (CHPW) is excited to announce a new value-added benefit for CHPW Apple Health members: For services starting February 1, 2021, CHPW will pay up to $200.00 for non-medically necessary circumcision.
Core Provider Agreement and NPI Status
We’ve updated our Core Provider Agreement and NPI Status information.
Read our Core Provider Agreement information and NPI status FAQs for more information➜
Pricing Methodologies
Primary Care Behavioral Health Billing Updates
Updates have been released from the Health Care Authority (HCA) related to billing codes related to behavior health services. Review these in consideration for your behavioral health services.
Z Codes as Primary Diagnosis - Denials for RHCs
Rural Health Clinics (RHCs), please be aware that as of March 3, 2023 neither CHPW nor the HCA will deny RHC claims if the specific Z codes in the below billing guide are billed as the primary diagnosis. Retroactive adjustments are still being determined by the Washington State Health Care Authority (HCA). CHPW will provide an update when we have more information.
Please feel free to contact Provider Relations at [email protected] or contact your Provider Relations Representative for any questions.
Review our Z Codes as Primary Diagnosis – Denials for RHCs billing guideline ➜
Claims
Learn how to view prior authorizations and referrals, as well enter claims in our HealthMAPS patient information portal.
Launch HealthMAPS Portal Training ➜
Download the below forms as PDFs and follow the instructions to manage your practice’s claims with CHPW.
- Claims Supporting Documentation Cover Sheet
- Corrected Claim – Standard Cover Sheet
- Hysterectomy Consent Form : Prior authorization and a consent form are required for hysterectomy. See our Provider Manual for more information.
- Sterilization Consent Form: A consent form is required for sterilization. See our Provider Manual for more information.
- Sterilization Consent Form – Spanish :A consent form is required for sterilization. See our Provider Manual for more information.
- 1500 Claim Form and Instructions
- UB04 Claim Form and Instructions
Questions?
Email our Provider Relations Team with questions about billing. One of our Provider Relations Representatives will contact you.
