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The former TPA, DXC, is now closed for business.
Mail paper claims to the current TPA at the appropriate address below. To submit claims for dates of service prior to 2018 electronically, continue to use only Payer ID 22521.
HealthChoice
P.O. Box 99011
Lubbock TX 79490-9011
DOC
P.O. Box 16532
Lubbock, TX 79490-6532
DRS
P.O. Box 16485
Lubbock, TX 79490-6485
For direct data entry of these claims, you must go through the provider portal at www.healthchoiceconnect.com. ClaimLink is no longer available for this service. Note: ClaimLink will remain available through Dec. 31 to view and download remittance advices for claims prior to 2018 paid before July 2018.
If you have questions, please contact the medical and dental claims administrator at 800-323-4314.
Remember to visit the new HealthChoice self- service provider portal, HealthChoice Connect, at www.healthchoiceconnect.com.
You can access:
- Claim status.
- Direct data entry of certification requests.
- Direct data entry of claims.
- Electronic payments.
- Electronic remittance advices in PDF.
- Eligibility.
- Member benefits.
When registering, you will need to use your contracted tax ID number and one contracted NPI number for authentication. Only one registration is required per TIN, as this will give you access to all contracted providers and NPI numbers under that TIN. Please note, the NPI number used must be an NPI number we have associated with your TIN. For physicians/practitioners, this would be the individual NPI number.
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DentalXChange offers direct data entry of 837D dental claims as a free service for dentists with HealthChoice, the Department of Corrections and the Department of Rehabilitation Services.
Follow this link to get started today. https://register.dentalxchange.com/reg/login;jsessionid=4a61e8e6bd22f5dfa6e64e9af36d?0
When registering, you will be asked for your practice management system. Open the drop-down menu and select the last option, Free DDE for Payer-Partner Claims Services. After you select Payer-Partner, a list of plans that the free services apply to will open. If you are unable to locate the free services:
- Select Contact Us and complete the online Sales Form.
- Call DentalXChange sales for assistance toll-free at 800-576-6412, ext. 455.
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The Availity web portal for the direct data entry of medical and dental claims is available as a free service to you. Submit claims to HealthChoice payer ID 71064.
Access the Availity web portal at www.availity.com. A link for Availity is also on the HealthChoice provider portal at www.healthchoiceconnect.com under Providers Additional Resources.
If you have any questions, contact Availity. Visit the Contact Us page on their website.
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Providers can appeal a claim payment or denial by submitting a letter to the medical and dental claims administrator at the address designated for appeals and provider inquiries within one year of the date on the first notice of the adverse determination.
Network providers can request a second-level appeal if the initial appeal is upheld and the network provider has additional information to submit for review. Submit a letter requesting another appeal of the claim to the medical and dental claims administrator at the address that follows for appeals and provider inquires.
Second-level appeals are available only to participating network providers.
Appeals and Provider Inquiries
HealthChoice
P.O. Box 3897
Little Rock, AR 72203-3897
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For charges incurred Oct. 1, 2018, and after, HealthChoice and the Department of Corrections will update the following fee schedules: comprehensive fee schedule for MS-DRG, MS-DRG LTCH, inpatient and outpatient tier designations, and inpatient and outpatient bariatric surgery. In addition, add, change and delete codes and other updates will be done as necessary for CPT/HCPCS, Outpatient, Ambulatory Surgery Center, and Select inpatient and outpatient fee schedules.
Inpatient and outpatient tier designations are updated annually on Oct. 1, based on the most current CMS fiscal year inpatient prospective payment system impact file for network providers.
Please refer to the following fee schedule updates and timelines:
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Jan. 1: Comprehensive fee schedule update for ADA, ASA, and Select inpatient and outpatient fee schedules.
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Jan. 1: Add, change and delete codes and other updates as necessary for CPT/HCPCS, OP, and ASC.
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April 1: Comprehensive fee schedule update for CPT/HCPCS, OP, and ASC.
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April 1: Add, change and delete codes and other updates as necessary for Select inpatient and outpatient fee schedules.
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July 1: Add, change and delete codes and other updates as necessary for CPT/HCPCS, OP, ASC, and Select inpatient and outpatient fee schedules.
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Oct. 1: Add, change and delete codes and other updates as necessary for CPT/HCPCS, OP, ASC, and Select inpatient and outpatient fee schedules.
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Oct. 1: Comprehensive fee schedule update for MS-DRG, MS-DRG LTCH, inpatient and outpatient bariatric surgery fee schedules and inpatient and outpatient tier designations.
As a reminder, the American Medical Association may periodically change, add or delete procedure codes throughout the year. When these modifications occur, HealthChoice and DOC will review the fee schedules as soon as possible and make any necessary changes. Additionally, HealthChoice and DOC make fee schedule updates on an ad hoc basis when needed.
If you have questions, contact network management at 405-717-8790 or toll-free 844-804-2642.
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The medical and dental claims administrator no longer accepts verification of other insurance submitted by the provider. The member must complete the verification of other insurance process through the member portal at www.healthchoiceconnect.com or by calling the medical and dental claims administratort toll-free at 800-323-4314.
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For dates of service beginning Jan. 1, 2018, HealthChoice has adopted industry standard claim editing guidelines, a combination of CMS, CCI, and McKesson claim editing criteria that have been evaluated for implementation based on plan experience.
To ensure our network providers have the best possible experience with our organization, we launched our new Advanced Communication Engine system. ACE is available to all direct submitters as well as those who transmit claims via clearinghouses or billing services. ACE Edits will appear on claim rejection reports (277CA).
ACE alerts you to deny certain claims through claim acknowledgment transaction reports with clear instructions on how to fix the error and access the supporting documentation that triggered the alert.
Claims failing the pre-adjudication editing process are not forwarded to our claims adjudication system.
ACE integrates into your current EDI workflow so you can modify claims before submission.
After you have reviewed the ACE Edit, if you choose not to change the claim, you can resubmit it in its original format and it will pass directly into our claims adjudication system for processing.
ACE does not require any downloads or changes in your current EDI work stream, and it’s available to you at no cost. Help improve clean claim rates and increase collections with actionable edit intelligence.
Providers should work with their existing clearinghouse/billing service to stress the importance of receiving a full 277CA claim submission report to include the ACE Edits.
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Have you visited the HealthChoice website recently?
With a much improved page structure that is easier to view and navigate, you will notice improved graphics and find more relevant search results. We aim to give you better access to the information you need. Visit www.healthchoiceok.com today and check it out!
For plan related questions, please continue to contact the medical and dental claims administrator toll-free at 800-323-4314.
Please share the Network News with:
- Office managers
- Referral and certification staff
- Business office staff
- Front office staff
- Medical records staff
- Providers
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Effective immediately, the fax number for the certification administrator has changed to toll-free 855-532- 6780. The new fax number is only for the certification administrator and not for the HealthChoice Health Care Management Unit.
To determine which services are certified through the certification administrator, please visit our website at omes.ok.gov/services/healthchoice/providers/provider-manual and refer to Certification.
To save time and help the certification process go smoothly, providers are encouraged to initiate certification with the certification administrator by completing the online form at www.healthchoiceconnect.com.
If you have questions about this process, please contact the medical and dental claims administrator toll-free at 800-323-4314.
The current medical and dental claims administrator will begin recouping overpayments for claims with dates of service prior to Jan. 1, 2018, which includes claims processed by the prior TPA for HealthChoice, DRS and DOC. Recoupment will be subject to the same process currently in place.
HealthChoice coverage for breast pumps and supplies is as follows:
Manual and Electric Breast Pumps
- One breast pump (manual or electric) at 100 percent of allowable fee for preganant or postpartum members per pregnancy.
- Must be obtained from a contracted HealthChoice durable medical equipment provider.
- Physician’s prescription required.
Breastfeeding Supplies
- Certain supplies at no cost during the postpartum period, applicable to billing codes A4281, A4282, A4283, A4284, A4285, and A4286.
If you have questions about breast pumps and supplies, call the medical claims administrator at 800-323-4314.
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Effective Jan. 1, 2018, HealthChoice updated the Wigs and Scalp Prostheses directive to clarify the quantity limit allowed per calendar year.
The benefit is as follows:
- One wig or scalp prostheses per calendar year is covered for members who experience hair loss due to radiation or chemotherapy treatment resulting from a covered medical condition.
- Must be obtained from a licensed cosmetologist or durable medical equipment provider.
- For non-Medicare plans, coverage is subject to calendar year deductible and coinsurance.
- For Medicare Supplement plans, coverage is not subject to calendar year deductible or coinsurance.
- Payment is per the HealthChoice fee schedule.
If you have questions about this benefit, call the medical claims administrator at 800-323-4314.
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For charges incurred Jan. 1, 2018, and after, DME rental requires the provider to submit the purchase price when the HealthChoice allowable is $100 or more. DME rental claims will be denied when the purchase price is not included.
If you have questions, contact the medical claims administrator at 800-323-4314.
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The Network News is the primary information source for HealthChoice Network Providers. The newsletter provides plan update information and notice requirements as set out in Section XI of the Network Provider Contracts. Currently, the Network News is mailed or emailed to each network provider on a quarterly basis, and is also available on the HealthChoice website at omes.ok.gov/services/healthchoice/providers/network-news.
In an attempt to obtain updated contact information for providers and facilities, HealthChoice will reach out to network providers to obtain updates to their designated contact’s email or mailing address. The update request contains a link to a downloadable form to update the designated contact information on file. Please keep in mind that the designation of a representative to receive notices requires the signature of an authorized official. The designated contact also has direct access to the fee schedule search engine if they are receiving notifications via email. Once completed, the form can be faxed to 405-717-8977. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov.
HealthChoice is launching this initiative to ensure the delivery of plan notices and other important information directly to your designated contact. Each provider’s designated email contact will receive the Network News and other important notices. For providers with multiple locations under one TIN, the contact must forward this information to all locations or submit an email address that automatically distributes an email to all locations.
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HealthChoice Providers
www.healthchoiceok.com
Medical and Dental Claims
www.healthchoiceconnect.com
HealthSCOPE Benefits
P.O. Box 99011
Lubbock, TX 79490-9011
Customer Care and Claims
Toll-free 800-323-4314
Toll-free Fax 800-496-3138
TTY 711
Toll-free TTY 800-545-8279
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
Toll-free 800-323-4314
HealthChoice HCMU
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
EGID.NetworkManagement@omes.ok.gov
ECHO Health
www.providerpayments.com
Toll-free 844-586-7463
Subrogation Administrator
McAfee & Taft 800-235-9621
DOC Network Management
https://gateway.sib.ok.gov/DOC
OKC Area 405-717-8750
Toll-free 866-573-8462
EGID.DOCNetworkManagement@omes.ok.gov
DOC Medical and Dental Claims
HealthSCOPE Benefits
P.O. Box 16532
Lubbock, TX 79490-6532
Toll-free 800-323-3710
DRS Network Management
https://gateway.sib.ok.gov/DRS
OKC Area 405-717-8921
Toll-free 888-835-6919
EGID.DRSNetworkManagement@omes.ok.gov
DRS Medical and Dental Claims
HealthSCOPE Benefits
P.O. Box 16485
Lubbock, TX 79490-6485
Toll-free 800-285-6815
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