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HealthChoice would like your facility to be part of the HealthChoice Select Program. HealthChoice Select is a program designed to reduce the costs of select services by contracting with select medical facilities to provide these services and bill HealthChoice for a single amount for all costs associated with the service on the date the surgery or procedure is performed.
Effective July 1, 2016, HealthChoice once again expanded the services covered under the Select program to include more of those with reasonably controllable cost variances, high consumer demand, and market growth.
Advantages of participating in the HealthChoice Select Program include:
- Procedures covered at 100 percent of Allowable Fees;
- No copays, coinsurance and/or deductibles to collect;
- Approximately 170,000 HealthChoice members in or near Oklahoma;
- Potential to increase patient volume;
- Dedicated provider directory on HealthChoice website; and
- Targeted marketing to HealthChoice members.
Visit the web page at https://gateway.sib.ok.gov/providersearch/SelectProgram.aspx for a full list of the services available under HealthChoice Select. Be aware that participating facilities are not required to provide all of the services covered under the program. Facilities can choose any combination of services and opt-in or opt-out at any time, according to existing contract notification provisions.
For more information about participating in HealthChoice Select, please contact network management. Refer to “Network Provider Contact Information” at the end of this newsletter. Email inquiries can be sent to
EGID.NetworkManagement@omes.ok.gov.
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As you are aware, effective Jan. 1, 2016, HealthChoice changed pharmacy benefit managers from Express Scripts to CVS/caremark. To assist us in completing the transition, HealthChoice is asking you to promptly file claims for HealthChoice High Deductible Health Plan members for charges incurred during 2015.
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The Office of Management and Enterprise Services Employees Group Insurance Department is updating the definition of emergency in all plan documents including provider contracts as follows:
The term emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition described in clause (i), (ii), or (iii) of section 1867(e)(1)(A) of the Social Security Act (42 U.S.C. 1395dd(e)(1)(A)). In that provision of the Social Security Act, clause (i) refers to placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, clause (ii) refers to serious impairment to bodily functions, and clause (iii) refers to serious dysfunction of any bodily organ or part.
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Details regarding improvements to the medical records request process will be coming soon! These changes will decrease the claims administration turnaround time.
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Maintaining confidentiality is especially important to patients seeking treatment for sensitive issues and improvements in our privacy processes are made on an ongoing basis. In order to better maintain patient confidentiality, HealthChoice, the Department of Rehabilitation Services and the Department of Corrections will require all providers to receive remittance advices electronically by Jan. 1, 2017. To avoid delays, you can enroll or register now to receive your remittance advices electronically.
You have the option to enroll for EDI 835 transaction set, otherwise known as ERA – electronic remittance advice. The 835 is an electronic version of your explanation of payment. ERA enrollment forms for Network Providers are available on the website at https://www.ok.gov/sib/Providers/Electronic_Remittance_Advice_(ERA)/index.html. If you need additional assistance, contact EGID Network Management. Refer to “Network Provider Contact Information” at the end of this newsletter. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov.
You also have the option to view ERAs through ClaimLink, our powerful, secure website. ClaimLink also allows you to quickly enter claims, request dental predeterminations, and check eligibility and claims status. Registration for ClaimLink is quick, easy and secure. To access ClaimLink, select “ClaimLink for Providers” from the drop-down menu under “ClaimLink” in the top menu bar.
To register, you need to have the following information available:
- Your 10-digit NPI number or your SSN (provider ID).
- Your provider identification number (PIN). To find your PIN, access your records by selecting “Provider Self Service” in the drop-down menu under “Providers” in the top menu bar. Your PIN number is also located on each “Remittance Advice.”
- A valid claim number issued by the medical and dental claims administrator and processed under the appropriate PIN.
After you complete your initial registration, you will be asked to create your own unique username and password.
Once you register as a provider, you can create delegates. For information on how to create a delegate, navigate to “FAQs” at the bottom of the ClaimLink home page. Your delegate will create a four-digit code like the last four digits of the delegate’s driver license or another four-digit code chosen by the user. The delegate code is assigned after you register for ClaimLink.
If you have questions regarding ClaimLink or need assistance registering, please contact the medical and dental claims administrator. Refer to “Network Provider Contact Information” at the end of this newsletter.
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CVS/caremark and CoverMyMeds automate the prior authorization (PA) process making it faster and easier for you to review, complete and track PAs. CoverMyMeds is a free electronic PA solution utilized by 70 percent of the pharmacy benefit managers and pharmacies in the marketplace today, which makes CoverMyMeds a one-stop shop for all of your practice’s PA needs.
CoverMyMeds allows electronic submission of all the necessary information for submitting a PA for a patient, and in some cases results in automatic approval of the PA in minutes, instead of hours or days.
Create a free account at www.covermymeds.com to start submitting and tracking your PAs online today.
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Effective Jan. 1, 2016, CVS/caremark is the pharmacy benefit manager for HealthChoice. While HealthChoice has terminated its Part D contract with the Centers for Medicare & Medicaid Services (CMS), Part D benefits continue to be provided to our members through the contract with CVS/caremark and its SilverScript Employer Prescription Drug Plan. Although CVS/caremark is responsible for making sure that providers who prescribe Part D drugs are enrolled in the Medicare program or opt out, HealthChoice would like to remind providers of this requirement. More information on this is available on the CMS website at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Prescriber-Enrollment-Information.html.
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For charges incurred on or after Oct. 1, 2016, HealthChoice and the Department of Corrections (DOC) will update the following fee schedules: comprehensive fee schedule update for MS-DRG and MS-DRG LTCH, quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, outpatient facility (OP), ambulatory surgery center (ASC), the American Society of Anesthesiologists (ASA), the American Dental Association (ADA), and Select inpatient and outpatient fee schedules. Rates for the outpatient procedures covered under the HealthChoice and DOC Select program that became effective July 1, 2016, will be fully phased in beginning Oct. 1, 2016.
Inpatient and outpatient tier designations are updated on Oct. 1 each year, based on the most current CMS fiscal year inpatient prospective payment system (IPPS) impact file for Network Providers.
Additional Fee Schedule Updates
- For charges incurred on or after July 1, 2016, HealthChoice and DOC updated the following fee schedules: comprehensive fee schedule update for CPT/ HCPCS, OP, ASC, ADA, and Select inpatient and outpatient fee schedules.
As a reminder, the American Medical Association periodically changes, adds, corrects and/or deletes procedure codes throughout the year. When these changes occur, HealthChoice and DOC review them as soon as possible and make any necessary changes. Additionally, HealthChoice and DOC make fee schedule updates on an ad hoc basis when necessary.
Fee schedule updates are reported in each issue of the Network News which is distributed quarterly to all Network Providers. Updates are also posted to the provider websites. We encourage you and your staff to reference the website of your provider network for the most recent fee schedule updates and other important information.
If you have questions, please contact network management. Refer to “Network Provider Contact Information" at the end of this newsletter. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov or EGID.DOCNetworkManagement@omes.ok.gov.
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On Oct. 1, 2016, HealthChoice will require that ADA codes D0364 through D0385 be certified for medical necessity through our certification administrator. To request coverage of these ADA codes under the health plan, you must provide a detailed letter of medical necessity to the certification administrator for review and consideration.
If you have questions, please contact the medical and dental claims administrator. Refer to “Network Provider Contact Information” at the end of this newsletter.
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HealthChoice and the Department of Corrections will begin covering ostomy bags and wafers under both the medical and pharmacy benefits for charges incurred on or after Oct. 1, 2016. Until Oct. 1, ostomy bags and wafers will be covered under only the pharmacy benefit. Ostomy supplies are subject to policy provisions and do not require certification.
If you have questions about coverage of ostomy bags and wafers, please contact the medical claims administrator. Refer to “Network Provider Contact Information” at the end of this newsletter.
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Effective Oct. 1, 2016, all HealthChoice health plans, excluding HealthChoice Medicare Supplement plans, will require certification through the HealthChoice Health Care Management Unit (HCMU) for mental health and substance use disorder services that exceed 20 visits. Currently this requirement is 15 visits. Through Sept. 30, 2016, certification will continue to be required for these services that exceed 15 visits.
If you have questions about these certifications, please contact HCMU. Refer to “Network Provider Contact Information” at the end of this newsletter.
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Medical and Dental Claims
HP Administrative Services, LLC
P.O. Box 24870
Oklahoma City, OK 73124-0870
Customer Service and Claims
OKC Area 405-416-1800
Toll-free 800-782-5218
FAX 405-416-1790
TDD 405-416-1525
Toll-free TDD 800-941-2160
Pharmacy
CVS/caremark
Pharmacy Prior Authorization Request
Toll-free 800-294-5979
Pharmacy Prior Authorization Request – SilverScript (Part D)
Toll-free 855-344-0930
Certification
APS Healthcare
P.O. Box 700005
Oklahoma City, OK 73107-0005
Toll-free 800-848-8121
Toll-free TDD 877-267-6367
FAX 405-416-1755
HealthChoice Health Care Management Unit
OKC Area 405-717-8879
Toll-free 800-543-6044, ext. 8879
HealthChoice Network Management
OKC Area 405-717-8790
Toll-free 844-804-2642
OKC Area 405-717-8750
Toll-free 866-573-8462
DOC Medical and Dental Claims
HP Administrative Services, LLC
P.O. Box 268928
Oklahoma City, OK 73126-8928
Toll-free 800-262-7683
OKC Area 405-717-8921
Toll-free 888-835-6919
DRS Medical and Dental Claims
HP Administrative Services, LLC
P.O. Box 25069
Oklahoma City, OK 73125-0069
Toll-free 800-944-7938
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Please share the Network News with:
- Office managers
- Referral and certification staff
- Business office staff
- Front office staff
- Medical records staff
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Providers
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