Beware: You May Be Using the Incorrect Clearinghouse
Adult Family Home providers should be careful to use the correct clearinghouse when enrolling for Managed Care Organization (MCO) claims. AFHC has learned that some providers are being routed to the wrong system, which can lead to unnecessary fees, delays, and billing problems.
What providers need to know
Providers who bill for clients receiving Community Behavioral Health Support (CBHS) or Intensive Behavioral Supportive Supervision (IBSS) services should use the CHPS Adult Family Home Claims Clearinghouse. This is the authorized clearinghouse for submitting MCO claims and is intended to simplify the billing process for Adult Family Homes.
AFHC is aware that some providers have mistakenly attempted to enroll through Smart Data Solutions (SDS). If you are being asked to pay a fee or premium in order to bill MCO claims, you may be using the wrong clearinghouse. The CHPS clearinghouse does not require providers to pay to access the MCO claims submission process.
Why this matters
Using the incorrect clearinghouse can create avoidable problems, including:
Unexpected enrollment costs.
Delays in getting set up for claims submission.
Confusion about where claims should be sent.
Possible interruptions in reimbursement.
To avoid these issues, providers should confirm they are enrolling through the correct CHPS platform before proceeding with claims submission.
Correct clearinghouse information
CHPS Adult Family Home Claims Clearinghouse
https://chpswa.org/adult-family-home-tpa/afh-claims-clearinghouse/
Providers serving clients receiving CBHS or IBSS services should enroll through this site to ensure MCO claims are processed correctly.
NPI reminder
If you do not already have a National Provider Identifier (NPI), you may need to apply before billing claims. The Washington State Health Care Authority provides guidance on the NPI process here:
https://www.hca.wa.gov/assets/program/National-Provider-Identifier-Fact-Sheet.pdf
Provider alert
If a clearinghouse asks you to pay a fee to enroll for AFH MCO claims, stop and verify that you are in the correct system. Using the wrong clearinghouse can create unnecessary costs and delay your ability to bill properly.
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Membership fees enable the Council to cover legal expenses and fund staff to advocate with the state and regulatory agencies. The participation of every adult family home is vital to ensuring fair regulations and rates that accurately reflect the costs of caring for our vulnerable adults. Consider becoming a member of the Council to help us continue improving conditions for all adult family homes in Washington State.