Rights and Billing Training
It is mandatory that all providers contracted with Community Health Plan of Washington successfully take the training and testing on these topics:
- Enrollee Rights and Responsibilities. All contracted providers must comply with applicable Federal and State laws that pertain to enrollee rights and take those rights into account when furnishing services to enrollees. The provider must self-report any violation by calling the Customer Service team at 1-800-440-1561, Monday-Friday, 8 am-5 pm.
- Training about enrollee rights and consequences for noncompliance.
- Quiz about enrollee rights and consequences for noncompliance.
- Training about consequences of noncompliance with enrollee rights.
- Quiz about consequences of noncompliance with enrollee rights.
- For more information, see the Community Health Plan of Washington policy: PC.152 Enrollee Rights and Protections Policy
- Advance Directives. The Plan is required to educate and inform members, employees, and providers about member rights related to an Advance Directive.
- Prohibition on Billing Enrollees for Covered Services. No contracted provider who provides covered services to Medicaid members (Healthy Options/CHIP or Disability Lifeline) may bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a member or their authorized representative for covered services provided pursuant to your provider agreement.
If a member chooses to pay for medical services that are not covered, the provider must maintain a central record that contains: 1) the charged amount; 2) the member's agreement to pay, if any; and 3) actions taken regarding the billing.
The provider must report to the Plan any member billing, whether or not the member chooses to pay for medical services that are not covered.- Training about prohibition on billing enrollees for covered services.
- Quiz about prohibition on billing enrollees for covered services.
- For more information, see the Community Health Plan of Washington policy: OP.469 Prohibition on Enrollee Charges for Covered Services Policy