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

OUTPATIENT AND SPECIALTY SERVICES

  • Chiropractic: Prior Authorization required for Medicare Advantage members who need more than 12 visits and qualifying WA Apple Health/FIMC members who are age 20 and under and need more than 12 visits. 
  • Hyperbaric Oxygen Treatment
  • Speech Therapy: Prior Authorization required for Medicare Advantage member who need more than 12 visits. WA Apple Health/FIMC members who are age 21 and over and need more than 6 visits have to submit a Benefit Limit Extension Form
  • Physical/Occupational Therapy:
    • Prior Authorization required for Medicare Advantage members needing more than 12 visits.
    • Prior Authorization required for WA Apple Health/FIMC members who are age 20 and under and need more than 12 visits.
    • WA Apple Health/FIMC members who are age 21 and over and need more than 6 hours have to submit a Benefit Limit Extension Form
  • Orthoptic/Pleoptic Training
  • Spinal Injections: Prior Authorization required for WA Apple Health/FIMC members. 

INPATIENT SERVICES

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

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.

Please contact CHPW with any questions or concerns.