Welcome to Community Health Plan
Community Health Plan is the second largest provider network in Washington State and represents the second largest network of community-based health centers in the country. The Plan contracts with dedicated providers throughout the state.
We are pleased you have chosen to participate in our network, and share in our commitment to provide quality care for those who traditionally face barriers to the care they need. We look forward to supporting you as a provider of Community HealthPlan.
2010 Provider Manual (PDF, 568K)
The 2010 edition of the Provider Manual incorporates updates and new content, such as:
- Directory of services and contacts UPDATES
- Provider Relations
- Access to care standards
- Credentialing UPDATES
- Access to enrollee health information
- Medical record documentation standards and policies NEW
- Eligibility
- Disenrollment
- ID cards UPDATES
- Enrollee benefits UPDATES
- Children First™
- Enrollee rights & responsibilities NEW
- Notice of Privacy Practices NEW
- Advance directives NEW
- Billing and claims payment
- Where to send claims NEW
- Appeals
- Care management and utilization management UPDATES
- Referrals
- Prior authorization
- Pre-existing conditions (Basic Health)
- Case management
- Referrals
- Member Review and Intervention Program (MRIP)
- Disease management
- Pharmacy management
- Formulary
- Prior authorization
- Benefit exclusions
- Quality program UPDATES
For tools and information, see these folders:
If you have questions regarding any policies and procedures explained in the manual, please contact your Provider Relations Coordinator: Phone 1-800-440-1561 or fax 206-613-5018.
