Summer 2020

In this issue

• COVID-19 coverage notice
• HealthChoice Select
• Diabetes Prevention Program
• HealthChoice certification portal enhancements
• HealthChoice IVR
• Timely filing for medical and dental claims
• Drug administration code
• HealthChoice certification list
• Fee schedule updates
• Contact information

News

COVID-19 coverage notice

Helping our members and providing support to the medical community is our No. 1 priority. For the latest information on coverage for COVID-19, refer to the HealthChoice website at omes.ok.gov/pages/information-healthchoice-members-and-providers-covid-19.

HealthChoice Select

Your patients with HealthChoice primary coverage may be able to get certain imaging, cardiology or surgical procedures covered at 100% if they utilize a HealthChoice Select provider.

HealthChoice Select is a program designed to reduce the costs of certain services by contracting with select medical facilities to provide these services with no out-of-pocket costs to members.

Customer Care is available to help guide referring providers and your members through the HealthChoice Select process and ensure members have a positive, beneficial experience. To verify a service is covered under HealthChoice Select and identify a participating provider, call 800-323-4314 and choose the appropriate prompt below:

• Providers select Option 2, then Option 3.
• Members select Option 3, then Option 5.

Members on the HealthChoice High Deductible Health Plan must meet their deductible before the plan pays any benefits, other than preventive services.

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Diabetes Prevention Program

HealthChoice implemented a benefit for coverage of the Centers for Disease Control and Prevention-recognized National Diabetes Prevention Program, contracting with provider organizations in Oklahoma that have achieved full CDC recognition. The CDC National DPP is a lifestyle change program that offers evidence-based, cost-effective interventions to help prevent Type 2 diabetes. The program is intended to create behavioral changes to improve healthy eating, increase physical activity and manage stress.

Participation in the program is offered as a preventive service. HealthChoice covers qualifying preventive care services at 100% of allowable fees for a qualifying code when rendered by a participating network provider. There are no copays, deductible or coinsurance applied under this benefit.

All HealthChoice participants who meet National DPP eligibility as established by a participating provider are eligible for one year in the program. Members who successfully meet the year one performance goal will be eligible to continue participation in ongoing maintenance sessions through year two.

To locate a network DPP, visit the HealthChoice Provider Search page at gateway.sib.ok.gov/providersearch/
SpecialtySearch.aspx#grid and search by specialty.

For additional information, call EGID Network Management at 405-717-8790 or toll-free 844-804-2642.

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HealthChoice certification portal enhancements

Through the HealthChoice certification portal, you can complete and submit a certification request form online. You can also upload documents when requesting certification for services reviewed by the HealthChoice Health Care Management Unit.

The certification portal is organized by services reviewed by HCMU and services reviewed by the certification administrator, AHH. These changes are only applicable to HCMU-reviewed services.

Note: Certification requests that are not accurately completed or are submitted to the incorrect area could be delayed or not processed.

Visit healthchoiceconnect.com and select Certification Portal under Providers Additional Resources. For questions or assistance navigating the portal, please call Customer Care at 800-323-4314. TTY users call 711.

HealthChoice IVR

HealthChoice Customer Care has updated the interactive voice response system.

To help us serve you better, please choose the option for provider. After following the prompts for eligibility or claim status, you have the opportunity to speak to a customer care representative. Listen and follow the prompts carefully so you will be directed through the call flow as efficiently as possible. We have a specialized team available to assist you, so please make sure to choose the provider option to speak with one of your dedicated representatives.

For additional information, call Customer Care at 800-323-4314. TTY users call 711.

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Timely filing for medical and dental claims

All HealthChoice and Department of Corrections contracts contain timely filing provisions.

To align with industry standard for timely claims processing, HealthChoice and DOC accept new, clean claims or corrected claims received no later than 365 days following the date the service or supply was rendered.

You are strongly encouraged to file claims according to the timely filing limits within your existing provider contract.

For additional information, call EGID Network Management at 405-717-8790 or toll-free 866-573-8642. TTY users call 711.

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Drug administration code

Effective Jan. 1, HealthChoice requires providers to indicate the drug name on drug administration claims, even if reimbursement for the drug is not being requested. HealthChoice will not pay for the administration charge unless the drug is covered and medically necessary.

For questions about this change, call Customer Care at 800-323-4314. TTY users call 711.

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HealthChoice certification list

The HealthChoice certification list, updated quarterly, is available through the online HealthChoice fee schedule at gateway.sib.ok.gov/feeschedule/Login.aspx. Log in to view the most recent list.

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Fee schedule updates

Future fee schedule updates for services provided by HealthChoice network providers are scheduled for:

*Comp – Comprehensive *A/C/D – Adds, changes, deletes and other necessary updates

As a reminder, national medical and dental associations may change, add, correct or delete billing codes throughout the year. When these modifications occur, EGID reviews them as quickly as possible and makes any necessary updates. Additionally, EGID performs fee schedule updates on an ad hoc basis when necessary.

The EGID tiers were created in part to help support the continued existence and financial viability of truly rural hospitals. EGID’s tier designation process is intended to only recognize a rural reimbursement methodology if the urban/rural status is based on the ZIP code of the hospital and the status of that ZIP code in the U.S. Census Bureau’s metropolitan core-based statistical area.

Inpatient and outpatient tier designations and facility urban/rural designations are updated annually on Oct. 1, based on the most current Centers for Medicare & Medicaid Services fiscal year inpatient prospective payment system impact file or the ZIP code of its physical location included in the U.S. Census Bureau’s metropolitan core-based statistical area. On Jan. 1, the urban/rural indicator is updated based on the most recent CMS ZIP code to carrier locality file for all facilities that are not hospitals.

For the most part, the applicable urban tier status is based on the most current CMS fiscal year inpatient prospective payment system impact file for network providers, unless the ZIP code of its physical location is included in the U.S. Census Bureau’s metropolitan core-based statistical area.
Inpatient and outpatient tier designations are defined as:

• Tier 1 – network urban facilities with greater than 300 beds.
• Tier 2 – all other urban and non-network facilities.
• Tier 3 – critical access hospitals, sole community hospitals, and Indian, military and VA facilities.
• Tier 4 – all other network rural facilities.

Following each quarterly update of the HealthChoice fee schedule, outpatient rates for the procedures covered under the program will fully phase in during the next quarterly update.

Fee schedule updates are reported in each quarterly issue of the Network News newsletter. If you need specific codes and allowable fees affected by these updates, please visit our website at gateway.sib.ok.gov/feeschedule/Login.aspx and view or download the latest fee schedule addendum. The fee schedule is not publicly disclosed. It is deemed confidential pursuant to 51 O.S. and should not be disseminated, distributed or copied to persons not authorized to receive the information. If you have questions or need additional information, please call EGID Network Management at 405-717-8790 or toll-free 844-804-2642.

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Contact information

HealthChoice Providers

www.healthchoiceok.com

Medical and Dental Claims
www.healthchoiceconnect.com

HealthSCOPE Benefits
P.O. Box 99011
Lubbock, TX 79490-9011

Customer Care

Toll-free 800-323-4314
TTY 711

Pharmacy

CVS/caremark

Prior Authorization Request

Toll-free 800-294-5979

Prior Authorization Request – SilverScript (Part D)

Toll-free 855-344-0930

Certification

AHH
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 888-834-3511

Subrogation Administrator

McAfee & Taft 800-235-9621

DOC Network Management
gateway.sib.ok.gov/DOC

OKC area 405-717-8750
Toll-free 866-573-8462
EGID.DOCNetwork
Management@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
gateway.sib.ok.gov/DRS

OKC area 405-717-8921
Toll-free 888-835-6919
EGID.DRSNetwork
Management@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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