Provider Billing and Claims - Washington State Local Health Insurance - CHPW

Provider Billing and Claims

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.

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.

Complete Attestation ➜

 

New and Updated 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 announce a new 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.

Read billing guidelines for acupuncture services ➜

Apple Health Dental Services Billing and Rendering Taxonomy Requirements

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.

Effective January 1, 2021, CHPW’s clearinghouse will reject any claims submitted without valid billing and/or rendering taxonomy codes and those claims will not be submitted to CHPW.

Read more about taxonomy code requirements ➜

Circumcision — Apple Health (Medicaid)

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.

Read billing guidelines for circumcision ➜

Core Provider Agreement Update

We’ve updated our Core Provider Agreement information. Please see our Core Provider Agreement for Medicaid Services FAQs.

Read more about updates to Core Provider Agreement information ➜

Pricing Methodologies Primary Care Behavioral Health Billing Updates

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.

Read more about updates to behavioral health billing ➜

UPDATED: 270/271 and 276/277 Transactions

As of December 1, 2018, NTT Data processes HIPAA 270/271 (Eligibility/Benefit Inquiry and Response) and 276/277 (Claim Status Inquiry and Response) transactions.

Read more about updates to 270/271 and 276/277 transactions ➜

 

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.

 

Electronic Funds Transfer (EFT)

Receive your payments faster by signing up for Electronic Funds Transfer (EFT). CHPW can issue EFTs to all healthcare provider types, including those receiving capitation.

Download EFT form as a PDF ➜

 

Questions?

Email our Provider Relations Team with questions about billing. One of our Provider Relations Representatives will contact you.

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