As a Community Health Plan of Washington (CHPW) provider, you can count on our support in caring for your patients. Find answers to questions you may have about our provider portals, training and orientation materials, and more.
How can I become a Community Health Plan of Washington provider?
Where can I find out more information on Provider Portals?
How do I know if a drug I prescribe is on the formulary?
You can review the formulary on our Prescription Drug Coverage page to identify which drugs are covered by CHPW and which require preauthorization. Drugs not listed on our formulary require prior authorization. You can submit prior authorization requests through our Care Management Portal (Jiva).
For self-administered drugs requiring prior authorization, please call 1-800-753-2851.
How do I submit a Prior Authorization request?
Providers should submit prior authorization through Care Management Portal (Jiva).
You can also fax prior authorization requests to 206-652-7065. Please check the fax number located at the top of each form as it may differ depending on the request. Find CHPW Prior Authorization forms here.
For pharmacy, providers should submit requests via ExpressScripts for prior authorization, step therapy, non-formulary, or quantity limit override. Call them at 1-800-922-1557 to speak with a prior authorization specialist. For professionally administered drugs follow instructions here.
All other prior authorization requests will be handled by CHPW staff. Please contact your provider relations representative for more information.
Who do I contact for claim status, prior authorization, member benefits, or member eligibility?
I have a patient who missed their appointment without warning. Can I still bill them?
No. Patients cannot be billed for missed appointments. Make sure they are aware of your clinic’s cancellation or late appointment courtesy policies.
My patient needs to see an out-of-network specialist. Can I still refer them?
Any request to see a non-network provider requires CHPW approval, regardless of whether the service requires prior authorization.
If you still have questions, call Customer Service for help. Our representatives are available at 1-866-907-1906 (TTY Relay: 711) Monday through Friday from 8 a.m. to 5 p.m.