Home For Providers Provider Manual Status Reporting, Program Counties, Medicare Providers

Status Reporting, Program Counties, Medicare Providers

Read about:

• Reporting Changes in Provider Status
• Provider Directory
• State Programs and Medicare
• Medicare Advantage Providers in the Health Care Setting

Reporting Changes in Provider Status

All Community Health Plan providers are responsible for giving notice at least 30 days in advance of provider changes such as tax identification, billing address, and practice locations. This ensures ample time for the plan to update all systems, notify enrollees, and prevent payment delay.

Primary care providers are also responsible for notifying Community Health Plan when their practice reaches capacity and they can no longer accept new patients. This notice should be in writing and will be effective the first day of the month following 45 days from receipt of the written notice.

All Community Health Plan providers are also responsible for giving notice of intended termination at least 120 days prior to the termination date. This ensures compliance with the Patient Bill of Rights as well as ample time for the plan to notify enrollees. If an enrollee is not notified at least 30 days prior to the termination date of his or her provider, the provider and Community Health Plan are required to continue care with the termination provider for 60 days from the date of actual notice to the enrollee.

Provider Directory

Our provider directory is available on this web site. This listing contains the most current list of all providers contracted with Community Health Plan.

As is the case with all provider listings, this list is subject to change and may not be a complete representation of our network. If a provider that you use is not contracted with Community Health Plan or if you have any questions, please contact your Provider Relations Coordinator via Customer Service at 1-800-440-1561.

The listing on our web site is updated on a monthly basis.

State Programs and Medicare

Community Health Plan participates in Healthy Options and the State Children’s Health Insurance Program in the following counties:

Community Health Plan participates in Basic Health in the following counties:

Community Health Plan participates in the Washington Health Program in the following counties:

Community Health Plan offers Medicare coverage through its Community HealthFirst™ Medicare Advantage Plan as follows:

Each Community Health Plan product has a specific set of rules governing who is eligible for coverage, the enrollment process, and the termination process. These rules are not established by Community Health Plan, but by DSHS for Healthy Options and the State Children’s Health Insurance Program, by HCA for Basic Health, and by CMS for Medicare.

For details about Healthy Options membership and eligibility, please see the Healthy Options section of the HRSA web site.

For details about the Children’s Health Insurance Program membership and eligibility, please see the Children’s Health Insurance Program section of the HRSA web site.

For details about Basic Health membership and eligibility, please see the Basic Health section of the Health Care Authority web site.

For details about Washington Health Program insurance membership and eligibility, please see the Washington Health Program site of the Health Care Authority web site.

For details about Medicare membership and eligibility, please see the Medicare section of the Centers for Medicare & Medicaid Services web site.

Community Health Plan will not refuse enrollment or re-enrollment, terminate an enrollee’s enrollment, or discriminate against an enrollee in any way because of his or her health status, the expectation of the need for frequent high-cost care, or the existence of a pre-existing physical or mental condition, including pregnancy or hospitalization.

Medicare Advantage Providers in the Health Care Setting

Community Health Plan understands that Medicare beneficiaries look to their health care professionals to provide them with complete information regarding their health care choices.

To the extent of their ability, providers may assist a beneficiary in an objective assessment of the beneficiary's needs and potential plan options that may meet those needs. Providers are permitted to make available and/or distribute marketing materials for all plans with which the provider participates and to display posters or other marketing materials announcing plan contractual relationships.

Our CMS contractual obligations prohibit providers from accepting enrollment applications or offering inducements to persuade beneficiaries to join Medicare Advantage plans. Providers also cannot direct, urge, or attempt to persuade beneficiaries to enroll in a specific plan based on financial or any other interests. In addition, providers cannot offer anything of value to induce a Community Health Plan enrollee to select them as the enrollee’s provider.

CMS is concerned with provider marketing activities for the following reasons:

• Providers may not be fully aware of all plan benefits and costs; and
• Providers may confuse the beneficiary if the provider is perceived as acting as an agent of the plan versus acting as the beneficiary’s provider.

Because providers are usually unaware of the full range of Medicare Plan options, they should refer their patients to other sources of information:

• Community Health Plan marketing representatives at 1-800-944-1247
• State Health Insurance Assistance Programs (SHIP)
• State Medicaid Office
• Social Security Administration Office, www.medicare.gov, 1-800-MEDICARE
• Providers may distribute Medicare and You or Medicare Compare Information from the CMS web site, www.medicare.gov.