Community Health Plan of Washington Medicare Advantage Plans Community Health Plan of Washington Medicare Advantage Plans

Provider Health Services

For members with complex diagnoses or special needs, we offer a variety of health services to help them manage their condition on a daily basis.

These health services are recommended for patients for whom Care Management may reduce the risk of adverse outcomes, those who have complex medical or behavioral health conditions or high psychosocial risk factors.

Health management and care management services are available at no additional cost. Patients can self refer to these services or their physician can refer them using the Care Management Referral Form. Please fax the completed form to 206-642-7073 or email a scanned copy to [email protected].

More information about each service is provided below.

Health Management

Health Management is part of the Medical Management Department. We work with the providing clinic to support a care plan that promotes the wellness of the member. This team consists of clinical and nonclinical staff in each of the following areas, all with the goal of ensuring an actionable care plan for members:

  • Care Management
  • Utilization Management
  • Medication Review and Adherence
  • Community Support Services

➞ Read more about Health Management

Care Management

Care management is a collaborative process that address the individuals health needs of our members. It involves the coordination of services to identify alternative options and educate members about resources available to them. A case manager’s role is advocacy, assessment, and coordination of care between multiple providers and the member. Members must be referred to the care management program.

➞ Read more about Care Management

Health Assessment

Patients with chronic diagnoses or special needs will fill out a Health Assessment prior to starting a health coaching or health management program. For access to a patient’s Health Assessment, please contact their case manager.

Dual Special Needs Plan (Dual Complete Plan & Dual Select Plan): Transitions of Care

Community Health Plan of Washington is committed to managing the transition of all Dual Special Needs Plan members (Dual Complete Plan and Dual Select Plan) from one care setting to the next, and back to their medical homes. This process will necessitate activities for us and the attending caretaker(s) at each service facility.

Please review and familiarize yourself with the following minimal expectations required to be completed whenever there is a Dual Special Needs Plan member planned or unplanned inpatient or discharge event.

They include but are not limited to:

  • A discharge summary
  • Medication list review with the member
  • Review of any required follow-on appointments

If you have questions regarding CHPW Medicare Advantage Plans or Policies, please contact your Provider Relations Representative.


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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