We’re here to make the billing process easy.
At Community Health Plan of Washington (CHPW), we aim to make it easy for you to find the billing information you need. Use the resources on this page to manage your practice’s billing, or see our Provider Manual for more information.
Please note that you can submit electronic or paper claims.
CHPW accepts electronic claims via the Availity Clearinghouse. More information is available in our Provider Manual, or you can contact Availity at (800) 282-4548. Please use CHPW’s Payer Identifier: CHPWA.
Paper claims should be sent to the address below. This includes professional, facility, and behavioral health claims for all CHPW benefit plans.
PO Box 269002
Plano, Texas 75026-9002
Balance Billing Training
We recommend newly contracted providers complete balance billing training within 90 days of their contract effective date.
Launch Balance Billing Training ➜
After completing the training you must also complete an attestation.
Billing Guidelines
CHPW billing guidelines may change over time. Below is the most recent guidance in alphabetical order.
*Click to see billing guidelines
Acupuncture Services — Apple Health (Medicaid)We are excited to offer an acupuncture benefit available to our adult Apple Health Members, ages 18 and older. Eligible members can receive up to 6 acupuncture visits from January 1 through December 31. Unused acupuncture visits do not roll over to the next calendar year.
The new value-added benefit allows our Apple Health (Medicaid) members access to acupuncture, chiropractic, and massage therapy services for all ages.
CHPW would like to remind all clinics and providers that claims must be billed with valid, appropriate taxonomy codes for the billing provider and, when applicable, the rendering provider.
CHPW’s clearinghouse has been rejecting any claims submitted without valid billing and/or rendering taxonomy codes and those claims are not submitted to CHPW.
Community Health Plan of Washington (CHPW) is excited to announce a new value-added benefit for CHPW Apple Health members: For services starting February 1, 2021, CHPW will pay up to $200.00 for non-medically necessary circumcision.
We’ve updated our Core Provider Agreement and NPI Status information.
Read our Core Provider Agreement information and NPI status FAQs for more information➜
Updates have been released from the Health Care Authority (HCA) related to billing codes related to behavior health services. Review these in consideration for your behavioral health services.
Rural Health Clinics (RHCs), please be aware that as of March 3, 2023 neither CHPW nor the HCA will deny RHC claims if the specific Z codes in the below billing guide are billed as the primary diagnosis. Retroactive adjustments are still being determined by the Washington State Health Care Authority (HCA). CHPW will provide an update when we have more information.
Please feel free to contact Provider Relations at [email protected] or contact your Provider Relations Representative for any questions.
Review our Z Codes as Primary Diagnosis – Denials for RHCs billing guideline ➜
Claims
Learn how to view prior authorizations and referrals, as well enter claims in our HealthMAPS patient information portal.
Launch HealthMAPS Portal Training ➜
Download the below forms as PDFs and follow the instructions to manage your practice’s claims with CHPW.
- Claims Supporting Documentation Cover Sheet
- Corrected Claim – Standard Cover Sheet
- Hysterectomy Consent Form : Prior authorization and a consent form are required for hysterectomy. See our Provider Manual for more information.
- Sterilization Consent Form: A consent form is required for sterilization. See our Provider Manual for more information.
- Sterilization Consent Form – Spanish :A consent form is required for sterilization. See our Provider Manual for more information.
- 1500 Claim Form and Instructions
- UB04 Claim Form and Instructions
Questions?
Email our Provider Relations Team with questions about billing. One of our Provider Relations Representatives will contact you.
