What happens if my prior authorization is denied? - Community Health Plan of Washington - Medicare Advantage

What happens if my prior authorization is denied?

If CHPW denies your request to administer certain services, treatments, equipment, or prescriptions drug, the member can appeal the decision and should follow the protocol on  the appeal and grievances pages.

If a drug is denied by Express Scripts, providers may appeal the decision by sending a letter and clinical
documentation, including the date and reason for the denial given by ESI, to:

Community Health Plan of Washington
Attn: CHPW Medicare Advantage Appeals
1111 Third Avenue, Suite 400
Seattle, WA 98101
Fax: (206) 613-8983

Expedited appeals are reserved for emergency situations only; call 1 (800) 942-0247 (Toll Free).

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Nurse Advice Line
Doctors in an emergency room with patient,What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, you can call our Nurse Advice Line for help. They can help you decide if you should see a primary or urgent care doctor. The Nurse Advice Line is free and available 24/7 for members at 1-866-418-2920 (TTY Relay: 7-1-1).

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