Home For Providers How to Find Important Information (for Providers)

How to Find Important Information (for Providers)

To request information or get a printed copy of any of the following information sent to you:

• Call Community Health Plan Customer Service at 1-800-440-1561, Monday–Friday, 8 am–5 pm.
• Call Medicare Advantage Customer Service at 1-800-942-0247, 7 days a week, 8 am–8 pm.
• Email customercare@chpw.org.

Find information about:

• Our credentialing process, including:
  • How we review information submitted to support a provider's credentialing application
  • How to correct information
  • How to, upon request, be informed of the status of the credentialing or recredentialing application
  • A description of how this information is distributed to providers
  • Online ProvderSource credentialing application hosted by OneHealthPort (New)
    
• How you can get our clinical practice guidelines.
• Treatment record policies including requirements for:
  • Confidentiality of treatment records
  • Documentation standards
  • Systems for organization of treatment records
  • Standards for availability of treatment records at the practice site
  • Performance goals to assess the quality of medical record keeping
  • A documented process describing treatment record policies and how the information is distributed to providers
• Our statement of member rights and responsibilities.
• Medical necessity criteria, including how to obtain or view a copy. See the individual program for specifics:
  • Basic Health.
  • Disability Lifeline (GA-U). 
  • Healthy Options/Apple Health or Children's Health Insurance Program (CHIP): See "Medically Necessary" in the Healthy Options/CHIP Medical Benefits Summary book. 
  • Community HealthFirst Medicare Advantage Plans: See "Definitions of important words" in the back of the Evidence of Coverage (EOC) for your Medicare Advantage plan. 
  • Washington Health Program:  See "Medical Necessity" in the Washington Health Program Medical Benefits Summary book.
• Our policy prohibiting financial incentives for utilization management decision-makers.
• Staff availability to answer questions about the utilization management process.
• The toll-free number to call to contact staff about utilization management issues.
• How to contact an appropriate peer reviewer to discuss utilization management decisions.
• How we evaluate new technology to include it as a covered benefit.
• Pharmaceutical management procedures.
• Our Quality Improvement Program, including goals, processes, and outcomes as related to care and service.
• How to refer members to the Case Management Program and how members may self-refer to the program.
• Disease Management Programs, including how to use the services and how the organization works with a practitioner's patients in the program.
• How to refer members to the Disease Management program.