Community Health Plan of Washington Individual and Family Cascade Select Plans Community Health Plan of Washington Individual and Family Cascade Select Plans

Provider FAQs

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?

To join our network, please fill out and submit an online Provider Enrollment form. We will review your information and contact you within 30 days. If you have questions, please contact our Provider Relations department at [email protected].  

Where can I find out more information on Provider Portals?

We want to make it easy for you to care for your patients. Use our Provider Portals page to submit and view requests, access patient information, and stay on top of your paperwork.

For portal-specific support, please contact [email protected].

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?

Providers can get in touch with our Provider Relations department at [email protected] or contact Customer Service for assistance at 1-866-907-1906 (TTY Relay: 711) Monday through Friday from 8 a.m. to 5 p.m.

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.


[random_content group_id='21' num_posts='1']


Sales Team

Get real answers
from real people

Phone: 1-833-993-0181
Email: [email protected]

The owner of this website has made a commitment to accessibility and inclusion, please report any problems that you encounter using the contact form on this website. This site uses the WP ADA Compliance Check plugin to enhance accessibility.