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2026 Formulary, Criteria and Policy Changes

Changes to the Apple Health Preferred Drug List (AHPDL) for CHPW Medicaid members effective 01/01/26, unless otherwise noted in this page.

Intensive Residential Treatment (IRT)

Billing tips for Intensive Residential Treatment (IRT)

Admit Dates for Outpatient Services

Reminders about admission (“admit”) dates for outpatient services on a professional claim

Access to Care Standards

Timely access to adequate and appropriate care based on approved accessibility standards for members

Faxing Issue Following Jiva 6.6 Upgrade

Due to a system error following our recent upgrade to Jiva version 6.6, some provider letters were inadvertently faxed multiple times

Center of Excellence (COE) Certification Training

Detailed Itemizations for Claims Over $100,000

All providers need to submit detailed itemizations for all claims with billed charges exceeding $100,000

Vaccines for Children (VFC) Billing

The guidelines when billing for the Vaccines for Children (VFC) Program

Youth and Young Adult Substance Use Treatment Webpage

A web page for youth and young adult substance use treatment information is now live

Electronic Funds Transfers (EFT)

CHPW is pleased to offer two options to sign up for or update EFT

New Medicare Benefit for 2026

New benefit for eligible Medicare Advantage Dual Complete (HMO D-SNP) members in 2026

HealthMAPS Portal Enhancements

CHPW is enhancing its provider portal in October 2025 to include access to remittances and claims letters.

Provider Newsletter

Read the latest updates and resources for providers and staff from Community Health Plan of Washington.

Clinical Practice Guidelines Update

CHPW guidelines for chronic diseases (including medical and behavioral health conditions) and for preventive services.

Sterilization & Hysterectomy Forms

Consent Forms are Required for Sterilization and Hysterectomy

How to Bill for Avastin (HCPCS J7999 and J9035) – Update

Phishing Fax Requests

CMS Alert: Medicare Fraud Scheme Involving Phishing Fax Requests

Behavioral Health Online Training Through Relias Academy

CHPW is offering extended behavioral health provider online training courses through Relias Academy

DOH licensure number on claims

Reminder regarding Department of Health (DOH) licensure number on claims

Behavioral Health Reminders

Providers must report all service codes that represent all OTP services required under state and federal law.

NURSE ADVICE LINE
(CHPW Members)
1-866-418-2920
(TTY:711)

CASE MANAGEMENT
TECHNICAL ASSISTANCE
(CHPW Members & Providers)
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☏ HAVE QUESTIONS ?

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Phone: 1-800-440-1561
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2026 Formulary, Criteria and Policy Changes

Intensive Residential Treatment (IRT)

Admit Dates for Outpatient Services

Access to Care Standards

Faxing Issue Following Jiva 6.6 Upgrade

Center of Excellence (COE) Certification Training

Detailed Itemizations for Claims Over $100,000

Vaccines for Children (VFC) Billing

Youth and Young Adult Substance Use Treatment Webpage

Electronic Funds Transfers (EFT)

New Medicare Benefit for 2026

HealthMAPS Portal Enhancements

Provider Newsletter

Clinical Practice Guidelines Update

Sterilization & Hysterectomy Forms

How to Bill for Avastin (HCPCS J7999 and J9035) – Update

Phishing Fax Requests

Behavioral Health Online Training Through Relias Academy

DOH licensure number on claims

Behavioral Health Reminders

QUICK LINKS

Language Assistance

☏ HAVE QUESTIONS ?

Get real answers
from real people

2026 Formulary, Criteria and Policy Changes

Intensive Residential Treatment (IRT)

Admit Dates for Outpatient Services

Access to Care Standards

Faxing Issue Following Jiva 6.6 Upgrade

Center of Excellence (COE) Certification Training

Detailed Itemizations for Claims Over $100,000

Vaccines for Children (VFC) Billing

Youth and Young Adult Substance Use Treatment Webpage

Electronic Funds Transfers (EFT)

New Medicare Benefit for 2026

HealthMAPS Portal Enhancements

Provider Newsletter

Clinical Practice Guidelines Update

Sterilization & Hysterectomy Forms

How to Bill for Avastin (HCPCS J7999 and J9035) – Update

Phishing Fax Requests

Behavioral Health Online Training Through Relias Academy

DOH licensure number on claims

Behavioral Health Reminders

QUICK LINKS

Language Assistance

☏ HAVE QUESTIONS ?

Get real answers from real people

Get real answers
from real people