How to Find Important Information: Medical Care Services

To Find Any of This Information

Click the links below, which will guide you to more information. You can read online or you can download a PDF to print.
To get a printed copy sent to you, contact the Community Health Plan customer service team at 1-800-440-1561, Monday through Friday from 8:00 am to 5:00 pm, or email customercare@chpw.org. If you are hearing or speech impaired, please call TTY Relay: Dial 7-1-1.

Your medical benefits: What is covered, how to get referrals and approvals, and more. (PDF)
Your pharmacy benefits: What is covered, how to find a pharmacy, and more. (PDF)
Payments for services not covered. (PDF)
Getting prior authorizations and referrals. (PDF)

Seeing a provider: Finding a provider, making an appointment, out of area care, and care when your clinic is not open.
Getting preventive care: Check-ups and preventive care, women's health care, and more.
Getting care when you are sick: How to get care from your PCP or specialist, get mental health and hospital care, and more.
Emergency care: What is an emergency, where to get emergency care, how to use urgent care centers, and more.

Quality improvement program: How we assess and improve patient safety and clinical quality, and more.
Care management by Community Health Plan of Washington.
Case management works with your providers to manage your care if you are very sick. You can self-refer.
Disease management works with your providers if you have a chronic disease, such as diabetes or asthma. You can self-refer.
Behavioral health management coordinates mental health care and substance abuse treatment with your providers.
Utilization management sets standards that guide providers and patients to use the highest quality, most effective care. When your doctor asks us for a prior authorization before a service or treatment, we use these standards to decide whether to approve or deny the request. Contact customer service to speak to utilization management representative about the standards or a specific decision. Includes:
- How we decide which new technology to include as a covered benefit.
- We do not offer providers financial incentives to use less expensive care.
Member Review and Intervention Program (MRIP) identifies and monitors patients at risk of using services and treatments improperly.

Advance directives give written instructions about your future medical care in case you cannot tell someone your medical wishes.
Your rights and responsibilities are standards for how we care for and communicate with each other.
Privacy policies and rights determine how we use your personal health information (PHI): (PDF)
- Routine consent and authorization to use, disclose, or release information about you.
- How to request access or changes to your PHI, or to request we restrict access to PHI.
- How the Plan protects your PHI.
- Our policy about sharing or disclosing your PHI with Plan sponsors or employers.
How you can help stop health care fraud and identity theft.
How to complain about a service or appeal a decision.