Effective November 1, 2025, Community Health Plan of Washington (CHPW) requires providers to submit detailed itemizations for all claims with billed charges exceeding $100,000.00.
Why This Matters
This requirement applies to all lines of business and is essential to ensure accurate calculation of outlier payments and to verify that CHPW is reimbursing only those services that are separately reimbursable under applicable Apple Health and Medicare guidelines and program limitations.
This policy supports CHPW’s commitment to:
- Ensuring compliance with state and federal reimbursement guidelines
- Promoting transparency in billing practices
- Preventing overpayments
- Ensuring program integrity
Itemization Format Requirements
To facilitate efficient review and processing, CHPW strongly prefers itemizations to be submitted in one of the following formats:
- .xml
- .csv
- .xls
- .xlsx
Itemizations must:
- Include the claim number(s)
- Clearly outline all billed charges associated with the claim(s)
- Include CPT and HCPC codes where appropriate
Please email itemizations to [email protected]. Claims submitted without the required itemization may be delayed or denied pending receipt of the necessary documentation.
Questions?
We appreciate your cooperation in implementing this important change. If you have questions or need assistance with submitting itemizations, please contact our Provider Relations team at [email protected].
