Community Health Network of Washington Cascade Select is a health insurance plan for individuals and families offered by Community Health Network of Washington (“CHNW”). For pharmacy coverage determination, please call 1-800-417-8164. Business Profile. Please take a few minutes to complete a brief survey about our providers. Hospice Care, Pediatric Concurrent Care, and Pediatric Palliative Care Policy (MM163) Pharmacy Review of Coverage Redeterminations (PM555) Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. The review is done by the appropriate licensed staff, which includes — but is not limited to — nurses, medical director, and pharmacist. Coverage Determinations and Exceptions Policy (PM554) Community Health Plan of Washington (CHPW) were founded in 1992 by Washington’s community health centers. Training courses are available on the CMS Medicare Learning Network website. STAR Kids Program: 1-855-607-7827 That includes expanding our virtual care services, making personal phone calls to check on you, and providing home delivery of your prescriptions. READ MORE. MA Pharmacy Plan 008 Utilization Management decision makers approve or deny based only on whether the care and service are appropriate and whether the care or service is covered. Transition Process Policy – MA (PM553). Benefit Limitation Extension Policy (UM428) All guidelines are reviewed at a minimum of once every two years. The coronavirus is affecting our communities in Washington, and Coordinated Care wants us to all stay as safe and healthy as possible.While there isn’t a vaccine for coronavirus yet, we can all work to prevent it by washing your hands often with soap and water for at least 20 seconds and staying home when you are sick. Community Health Plan of Washington does not reward providers or others for denying coverage or care. The guidelines also ensure that the criteria used for utilization management decisions are current. Current policies that you need to care for members can be found below. Our decisions are fair and equal. Eligibility: 1-800-562-3022 or submit questions online; Coverage, Claims & Billing: 1-800-562-3022, submit questions online, or find local help Contact Your Health or Dental Insurance Company All clinic staff – including CEOs, senior leaders, managers, clerical/admin staff, physicians, and other clinical staff – are required to receive this training. To enroll in a Community Health Plan of Washington Medicare Advantage plan, you must be eligible to receive Medicare Part A and Part B and live in our service area (Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Pierce, Okanogan, Skagit, Snohomish, Spokane, Thurston, Walla Walla,Whatcom, and Yakima counties in Washington state). Health Insurance. If you have a life threatening emergency, please contact 911. UnitedHealthcare Community Plan of Kentucky supports the Kentucky state goals of increased access, improved health outcomes and reduced costs by offering Medicaid benefits to the following members: Children, from birth through 18 years of age, eligible for Medicaid under expanded pediatric coverage provisions of the Social Security Act. MA Plan 006 TALK TO AN EXPERT; Click here to schedule a plan review. If CHPW upholds the original claim denial, non-contracted providers have the right to ask the CMS contracted IRE to review the appeal. Note: If you are a Dual Eligible Special Needs Plan (SNP) member, please refer to the hardcopy Provider Directory to assist you in obtaining access to providers who accept both Medicare and Medicaid. Premiums Disclaimer: You must continue to pay your Medicare Part B premium. CHPW members have the right to language access services when they attend a health care appointment and may present a Language Assistance Card to their provider to request interpreting needs . Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…. Box 26… Paper copies of the guidelines are available for members or providers on request, as well as at the links provided. Pharmacy Access During a Federal Disaster or Other Public Health Emergency Declaration Policy (PM514) Address 1100 New Jersey Avenue, S.E., Suite 840 Washington, DC 20003 Call Us Tel: (855) 326-4831 Tel: (202) 821-1100 CareFirst CHPDC Health and Wellness Centers. Claims for Medicaid members should be sent to Provider One. Business Profile ... Community Health Plan of Washington. We use information from your doctor to do this. CHPW cannot begin the appeals process without a signed WOL. If you have any questions about filling out and submitting online or paper forms, please contact Customer Service for assistance. A Reset font size. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is an independent licensee of the Blue Cross and Blue Shield Association. Authorization and Certification Policy (UM203) STAR Program: 1-800-434-2347. Claim Share Print. Would like to change to UnitedHealthcare community Plan prefer are in the member benefit grid, refer to appropriate... Blue Shield Association Trillium community Health Plan ( District of Columbia ) statement management decisions current. Talk to an EXPERT ; Click here to schedule a Plan review to providers of care are prior! If you have a life threatening emergency, please contact Customer Service for assistance CMS IRE. Click here to schedule a Plan review a fair hearing within 120 calendar from. 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