Forms and Tools
Case Management Referral Form
Children First™ Prenatal Form (English)
Children First™ Prenatal Form (Spanish)
Children First™ Well-Child/Immunization Program Form (English)
Children First™ Well-Child/Immunization Program Form (Spanish)
Clinic/PCP Selection Form
Consent for Appeal Form
Corrected Claim – Standard Cover Sheet
Disease Management Referral Form
Hysterectomy Consent and Patient Information Form
Medical Recordkeeping Practices Tool
Notification of Facility or Hospital Inpatient
Patient Complaint Form
Pregnancy Notification Form
Prior Authorization Form
Provider Add Change Term Form
Report Potential Fraud Form
Site Review Visit Tool
Standard Referral Form
Sterilization Client Statement Form
Sterilization Consent Form
Sterilization Consent Form – Spanish
Supporting Documentation Cover Sheet
Provider Manual
- Compliance Program & Program Integrity
- Provider Relations
- Policies and Procedures
- Forms and Tools
- References and Other
- Welcome to Community Health Plan of Washington
- Billing and Claims Payment
- Care Management
- Case Management
- Provider Directory and Counties
- Eligibility
- Enrollee ID Cards
- Enrollee Benefits
- Compliance Program & Program Integrity
- Interpreter Services
- Billing and Claims Payment
- Appeals
- Care Management
- Utilization Management
- Prior Authorization List and Utilization Guidelines
- Case Management
- Member Review and Intervention Program (MRIP)
- Disease Management Program
- Clinical Care Management Criteria
- Pharmacy Management
- Quality Improvement Program
- Get More Information