Community Health Plan of Washington, a not-for-profit organization, is the only Washington State health plan founded by local community health centers. We invest and foster growth in the communities where our members get care.
Providers rate Community Health Plan highly:
- In 2009, providers rated Community Health Plan the highest in call center and member services Staff among all other plans they participate in.
- More providers rate Community Health Plan as excellent or very good compared to all other providers in Washington State.
- 80 percent of providers would recommend Community Health Plan to other physicians.
Read In the Loop, your new provider newsletter
In the Loop is the newsletter from Community Health Plan of Washington that tells you about important updates to programs, tools to make credentialing and claims processing easier, and information to help you manage your relationship with the Plan and your patients. We hope you'll like our February 2013 In the Loop, available online now.
How to retrieve encrypted email from Community Health Plan
If you receive email containing PHI from Community Health Plan of Washington (the Plan), you will need to create an account with our email encryption software, Proofpoint, and enter a password to retrieve it. This applies only to email containing PHI or information that looks like PHI. Proofpoint uses filters to determine whether an email contains PHI or not; in some instances you may receive email that has been encrypted that does not contain PHI.
Please retain your password, and keep it in a safe place. You will use the same password to access all Plan email that has been encrypted. If you forget your password, you can reset it with Proofpoint.
If you receive an encrypted email from Community Health Plan and aren’t sure how to retrieve it, instructions are available here for download. (Adobe reader required.)
Quick Links for Providers
- Medical Care Services (formerly Disability Lifeline/GA-U)
- HIPAA 5010 and ICD-10: Will You Be Ready?
- How to Find Important Information (for Providers)
- Claims Information System Transition
- Provider Manual
- Provider Guidelines
- Provider Training
- 2013 Prior Authorization List
- Benefit Grids
Changes to the Disability Lifeline Program took effect November 1, 2011. Most enrollees receiving Disability Lifeline medical and mental health care benefits are now Medical Care Services enrollees.
For details, see:
- Medical Care Services (formerly DL/GA-U) begins November 1, 2011
- Housing and Essential Needs (HEN) replaces cash program
- New programs for former DL-X, DL-A, DL-D clients and for pregnant women not eligibile for TANF
- Advice for clients on DL-U (and not DL-X, DL-A, or DL-D) who are losing cash assistance
For information about benefits, see the member Medical Care Services web page.
Please contact Erin Hafer (firstname.lastname@example.org) with any questions.
Major federally mandated changes are coming by 2012 to the standards for HIPAA-designated health care electronic transactions, such as claims, remittances, referrals, and eligibility. In addition, ICD-9 diagnostic and procedure coding must change to version ICD-10 by October 1, 2013.
These changes are mandatory. After January 2012, claims will not be paid if they are submitted without the new HIPAA 5010 electronic file format. After October 1, 2013, claims will not be paid if they are submitted without the ICD-10 diagnostic and procedure codes.
- Important Milestone Dates
- HIPAA Version 4010 to 5010 Changes
- 5010 Resources
- ICD-9 to ICD-10 Changes
- ICD-10 Resources
Update: Washington Immunization Program
There are important changes to the Washington Immunization Program that are related to the new Washington Health Program (WHP). All recommended childhood vaccines will continue to be covered for children under the age of 19 because of House Bill 2551.
The cost of vaccines given to children under the age of 19 on WHP are not covered by the State sponsored immunization program. Community Health Plan of Washington will reimburse the Washington Vaccine Administration for the serum cost of these vaccines. Vaccines provided to children on WHP need to follow the guidelines set forth by the new Washington Vaccine Association. Please visit http://www.wavaccine.org. For all other programs, the process will continue as it has in the past.
Who pays for the vaccine serum?
|Basic Health (BH)||State Immunization Program|
|Healthy Options (HO)||State Immunization Program|
|Children’s Health Insurance Program (CHIP)||State Immunization Program|
|Washington Health Program (WHP)||Community Health Plan through WVA|
Please continue to order vaccinations for all programs through the State Department of Health. As well, Community Health Plan will continue to process the administration charges for the vaccine. For vaccines administered to WHP children, you need to submit a second claim form to Community Health Plan that includes the Washington Vaccine Association tax ID number. When we process the claim for vaccines provided to children under the age of 19 on WHP, we will send the administration fee payment to you and the appropriate assessment to the Washington Vaccine Association.
On the Washington Vaccine Association website you can find information about how to file dosage based assessment (DBA) claims. After reviewing materials on the Washington Vaccine Association website, if you have questions you may contact Community Health Plan customer service, the Washington Vaccine Association, or the Department of Health Immunization Program.
Claims System News
Since September 2009, we have been sending news and tips by email to those who sign up for our mailing list. To sign up for the list, enter your information on this page, and then click the Submit button. (You don't need a passcode.) That's all you need to do! The email list is the quickest way for you to get news.
Claims System Links
- Claims system and portals news and issues
- Health Information Portal (HIP) home page
- Care Management Portal (Jiva) home page
- Portal training
If you cannot get the information you need at these locations, please call our customer service team at 1-800-440-1561 (toll free) or contact us by email. Customer Service continues to be a source of current information, but call volumes have been high since the claims system go-live.