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?
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 regarding your request. If you have questions, please contact our Provider Relations department at Provider.Relations@chpw.org  
Where can I find more information about using Jiva?

If you are new to using the Jiva portal, read our frequently asked question guide.

For portal specific support, please contact portal.support@chpw.org.

 

How do I register for the HealthMAPS portal?

Register for HealthMAPS here You need your Billing Tax ID number(s) to register. It may take up to 10 calendar days for your registration to process. You will receive an email when your registration is complete.

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?

Out-of-network specialists require prior authorization and must meet certain criteria, for example, if there is not a similar in-network provider who can perform the same service. Submit a prior authorization request to get started.

 

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.

DID YOU KNOW...?

Required Training

Providers are required to complete a Fraud, Waste, and Abuse training within 90 days of contracting with CHPW and annually thereafter. All clinic staff – including CEOs, senior leaders, managers, clerical/admin staff, physicians, and other clinical staff – are required to receive this training. Training courses are available on the CMS Medicare Learning Network website.

More information can be found in our Provider Manual.

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We are now 
Community Health Plan of Washington
Medicare Advantage


With a new name comes new benefits.
Our  2020 Medicare Advantage plan details
will be available on October 1st, 2019.

 

Bookmark this page for updates!