As a CHPW provider, we support you in caring for our members – your patients. Find answers to questions you may have about our provider portals, accessing training and orientation materials and more.
Providers Frequently Asked Questions
How can I become a Community Health Plan of Washington Provider?
How do I know if a drug I prescribe is on the formulary?
You can review the formulary lists to identify what drugs are covered by CHPW and which require pre-authorization. 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 contact Express Scripts at 1-844-605-8168 or use https://www.CoverMyMeds.com to start the prior authorization process.
Who do I contact for claim status, prior authorization, member benefits or member eligibility?
Providers can get in touch with their Provider Relations Representative or contact customer service for assistance at 1-800-942-0247.
I have a patient that 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?
You may refer your patient to a non-networked provider without submitting a prior authorization request.
If you still have questions, call Customer Service for help. There are available from 8:00 a.m. to 8:00 p.m., seven days a week at 1-800-942-0247.