COVID-19 Provider Bulletin - Washington State Local Health Insurance - CHPW

COVID-19 Provider Bulletin

Community Health Plan of Washington Information on COVID-19

 

Provider Bulletin: April 28, 2021

Dear Provider:

We are providing the latest information for you regarding your work with CHPW around COVID-19. Please share this information with your clinical and administrative staff, as needed.

CHPW is ready to partner with you in any way we can be of assistance. You are not alone. Please reach out to [email protected] if you think of anything.

UPDATED INFORMATION (as of 04/28/2021. Information is subject to change.)

The information in this section reflects new or revised information since the last dated bulletin.

COVID-19 Utilization Management Update

On March 20, 2020, CHPW sent a bulletin out to providers advising them of several temporary accommodations to Utilization Management processes to ensure we adapted to the needs during the pandemic. Those temporary accommodations will expire on July 1, 2021.

Starting July 1, 2021:

  • Durable Medical Equipment – all DME that requires prior authorization must have that in place as outlined on our Prior Authorization List: https://www.chpw.org/wp-content/uploads/provider/2021-Prior-Authorization-List-and-Utilization-Guidelines-Medical-Surgical.pdf.
    • Previously, allowances were made to approve all DME for members transitioning from an acute facility.
  • SNF/IP Rehab – we will return to normal operations and all SNF and inpatient rehab stays will require authorization.
    • Previously, allowances were made to approve the first 10 days of any SNF or inpatient rehab stay without review to facilitate faster discharges from acute facilities.
  • Hospital Transfers – CHPW will resume requiring CHPW approval and authorization for any lateral transfers from one facility to another.
    •  Previously, allowances were made to allow lateral transfers from one acute facility to another (as long as medical necessity was still met) to support facilities that had surges in admissions.
  • Home Health and Respiratory Care – CHPW will resume requiring prior authorization for all Home Health services and those respiratory devices listed on our Prior Authorization List: https://www.chpw.org/wp-content/uploads/provider/2021-Prior-Authorization-List-and-Utilization-Guidelines-Medical-Surgical.pdf
    • Previously, allowances were made to temporarily remove prior authorization requirements for home health and respiratory devices.
  • Prior Authorization – CHPW will resume the contractual requirement for receiving prior authorizations for services on our Prior Authorization list; as applicable we will deny any requests that are received after the service is rendered. Providers and members will receive their appeal rights on those denials for not obtaining prior authorization as required.
    • Previously, CHPW temporarily allowed retro authorizing to support providers and facilities.

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