Community Health Plan of Washington supports specific electronic transactions. Learn how to submit electronic claims and more with these FAQs.

Q: Which electronic transactions does Community Health Plan of Washington support?

A: We currently support these electronic transactions:

  • 270: Eligibility, coverage, or benefit inquiry
  • 271: Eligibility, coverage, or benefit information
  • 276: Health care claim status report
  • 277: Health care information status notification
  • 834: Benefit enrollment and maintenance
  • 835: Health care claim payment advice
  • 837: Health care claim
  • ACH payments: Automated clearing house (ACH) payments are electronic payments often referred to as direct deposit or electronic funds transfer (EFT).

Q: What do I need to do to submit electronic claims?

A: To start submitting electronic claims, contact your software vendor to learn about options for installing electronic claims systems and choosing a clearinghouse.

The use of an electronic clearinghouse for claim processing, payment, status and eligibility has the following benefits:

  • 24 hour availability
  • Claims are submitted faster with real-time status updates
  • Access to real time, accurate benefit eligibility information
  • Lower processing costs

Community Health Plan of Washington uses Availity for our 837/835 transactions. Our Availity Payer ID is CHPWA.

  • Once you are ready to send electronic claims, contact Availity to enroll. Please refer to the 835/ERA Enrollment Form on the Forms and Tools page or contact Availity Client Services at 1.800.AVAILITY (282.4548) for more information.
  • If you are using another clearinghouse, please complete the Receiver Information section with your clearinghouse’s contact information and submit the Availity enrollment agreements and forms. You may email, fax, or mail the form to Availity. Instructions are included at the bottom of the last page of the form.

Q: How do I get 835 files?

A: To receive 835 files, please complete the Availity 835 enrollment form. You may also want to review the questions & answers in this FAQ about submitting electronic claims and completing the 835/ERA Enrollment Form.

  • If you are using another clearinghouse, please complete the Receiver Information section for your clearinghouse and have the provider sign the form and submit it to Availity. Please note, Availity will not accept the form without the provider’s signature. You may email, fax, or mail the form to Availity. Instructions are included at the bottom of the last page of the enrollment form.
  • If you receive paper RA’s and you sign up for 835 and/or EFT, we will automatically turn off your paper RA’s within 90 days.
  • If you have questions about enrolling for electronic RA or 835 files or if you would like to stop receiving paper RA’s, please contact EDI.Support@chpw.org.

Q: Who do I contact if I have a question about claim message codes?

A: Please contact edi.support@chpw.org if you have questions about Community Health Plan of Washington’s reason codes, or about CARCs and RARCs.

Q: Who do I contact for claim(s) issues?

A: Please contact cs.claimsdistribution@chpw.org for:

  • Fee schedule issues
  • Anesthesia pricing issues
  • Negative balance issues
  • Re-occurring benefit configuration issues
  • Interim billing issues
  • Endoscopic pricing issues
  • Multiple surgery pricing issues
  • Ambulance pricing issues
  • DRG pricing issues
  • Re-admission issues
  • Health homes
  • Applied behavioral analysis (ABA) claims
  • ICD-10 billing issues

We request that all providers continue to call Customer Service for all other inquiries not listed above:

  • State (Medicaid) Customer Service, (800) 440-1561
  • Medicare Advantage Customer Service, (800) 942-0247

Q: How do I use electronic banking to receive payments?

A: To enroll in ACH/EFT payments, please complete the ACH enrollment form (https://www.chpw.org/resources/Providers/EFT_form_electronic_signature.pdf) and submit the form to Community Health Plan of Washington by mail or email; both addresses are listed on the enrollment form. The ACH enrollment form is a 1-page PDF.

  • Once we receive the form, we will send a test file to your bank during our regularly scheduled check run; this is called a pre-note. If that file transfer is successful you will start receiving ACH/EFT payments the next time you have a paid claim (during our regularly scheduled check run).
  • Our claims processing starts on Friday night. ACH/EFT payments will be sent to your bank account as early as Monday evening.
  • We will send paper remits to the billing address we have on file for your first two payment cycles. If you do not receive your paper remits for your first two payments, please contact EDI.Support@chpw.org. We will automatically turn off your paper RA’s within 90 days of your second payment cycle.

Q: How do I complete the 835/ERA Enrollment Form?

A: Access the Availity 835/ERA Enrollment Form, a 4-page PDF, from our website at https://www.chpw.org/resources/multipayer_era_835_enrollment.pdf.

Pages 1 through 3 of the Availity enrollment form give an overview of the ERA process, instructions for completing the form and where to send it, and detailed descriptions of the information you need to provide (the form fields you need to complete) to sign up for ERA.

Page 4 of the form has all of the fields that you need to fill in before you send the completed, signed form to Availity.

When you’re ready to fill out the form:

  • To complete a text field, click in a blue area and type your response.
  • To place a checkmark in a checkbox, click once in the appropriate checkbox to mark it with an “X”.
  • Make sure to fill out the Receiver Information section with the information for your clearinghouse, or with the provider’s information if the provider does not use Availity.

Q: How do I turn off paper RAs?

A: Please contact edi.support@chpw.org and let us know you would like to stop receiving paper RAs. After we receive your request, we will turn off your paper RAs right away.

In addition, if you receive paper RAs and you sign up for EFT and/or 835, we will automatically turn off your paper RAs within 90 days.

Q: How do I check claim status?

A: You can check claim status (276/277 transaction) if you are signed up with Emdeon. Please contact Emdeon at http://www.emdeon.com/enrollment/ to enroll using Community Health Plan of Washington’s Emdeon payer ID, CMTWA. You may also want to review the questions & answers in this FAQ about submitting electronic claims and completing the 835/ERA Enrollment Form. You can also check claim status on a claim by claim basis through the Health Information Portal (HIP) at https://hip.chpw.org/login.asp. Please refer to the Health Information Portal (HIP) Training Workbook (https://www.chpw.org/resources/HIP_for_Providers_Training_Workbook.pdf) for more information.

Q: How do I check a patient’s (CHPW member’s) eligibility?

A: To check member eligibility, coverage, or benefit inquiry (270/271 transaction), you need to be signed up with Emdeon. Please contact Emdeon at http://www.emdeon.com/enrollment/ to enroll using Community Health Plan of Washington’s Emdeon payer ID, CMTWA. You may also want to review the questions & answers in this FAQ about submitting electronic claims and completing the 835/ERA Enrollment Form.

Q: How do I complete the ACH Enrollment Form?

A: Access the ACH enrollment form from https://www.chpw.org/resources/Providers/EFT_form_electronic_signature.pdf. You will need to print the form (a 1-page PDF), complete it manually (by writing or typing your answers), then mail a paper copy or scan and email an electronic copy as instructed on the form. (ACH is also known as electronic funds transfer, or EFT.)

Q: Why do I receive a weekly EFT notification email?

A: Community Health Plan of Washington is required to notify you, the provider, when we make a deposit to your account. We must provide the amount of the deposit, the date, and an EFT number as a way for you (and us) to trace the deposit. If you have a question about your deposit, give us the EFT number and we can find the 835 file and trace the payment.

Q: How do I change the email address for receiving the weekly EFT notification email?

A: Please contact edi.support@chpw.org to change the email address for the weekly EFT notification email.

Q: How do I change my bank account information for EFT or ACH?

A: To change bank information for ACH/EFT payments, please complete a new ACH enrollment form, available from https://www.chpw.org/resources/Providers/EFT_form_electronic_signature.pdf, and submit the form to Community Health Plan of Washington by mail or email; both addresses are listed on the enrollment form. The ACH enrollment form is a 1-page PDF.

Q: Who do I contact if my 835, RA, or explanation of payment (EOP) is missing?

A: Please contact Community Health Plan of Washington’s Customer Service department if your 835, RA, or EOP is missing.

  • State (Medicaid) Customer Service, (800) 440-1561
  • Medicare Advantage Customer Service, (800) 942-0247

Q: What if I have questions that aren’t addressed in this FAQ, or about specific transactions?

A: Please contact edi.support@chpw.org with questions about enrolling for electronic RA or 835 files, or about any of the electronic transactions that CHPW supports.

As a reminder, our Provider Manual is available on our website at https://www.chpw.org/for-providers/manual-for-providers/. In it you will find a directory of contacts within and outside of Community Health Plan of Washington; information about our Washington Apple Health and Medicare Advantage plans and service areas; provider responsibilities; billing and claims payment information; and more.

We also post information to the Provider Bulletin Board, https://www.chpw.org/for-providers/bulletin-board/ to let you know about topics of interest to you. For example, CMS updates, programs available to your patients who are CHPW members, new and revised codes, claims processes, etc.

You may also want to review the Implementation Guides and the Encounter Data Companion Guides: