Claims can be submitted by paper, HIPAA 837 electronic claims submission or through the provider portal at www.healthchoiceconnect.com.
Electronic Claims Submission
Providers can submit claims electronically utilizing clearinghouses in conjunction with the electronic claims payer ID 71064.
All electronic transactions must conform to HIPAA 5010 standards. Claims that are not in compliance are either rejected or denied.
If you consistently have issues with the claims that do not process quickly, please verify the format your intermediary or clearinghouse uses to submit your claims. Make sure they are filing your claims electronically and not on paper; it takes much longer to process paper claims.
When you submit a claim electronically and then submit a duplicate paper claim, it can significantly slow down your payment. If you submit a claim and need to verify payment, please contact our medical and dental claims administrator or log in to the provider portal to check the status. Resubmit a claim only if it is not already on file. When the same claim is submitted multiple times, each additional claim can deny as a duplicate and further delay the adjudication process.
Direct Data Entry
Providers have the ability to submit individual claims without any intermediary software through the direct data entry feature on Availity. The direct data entry feature allows providers to submit individual medical, dental or hospital claims directly to the claims administrator. The provider receives an immediate response regarding the status of the claim with real time responses indicating if the claim has been paid, denied or suspended. The direct data entry of claims feature can be accessed through the provider portal.
DentalXChange is a free service for dental providers, provided by HealthChoice, for the direct data entry of dental claims. Dental providers can register for this service through DentalXChange.
Paper Claims Submission
Under the terms of the HealthChoice Network Provider contract, HealthChoice network providers are required to file claims for HealthChoice members. Providers should submit claims on forms acceptable to HealthChoice within 365 days of providing the medical services, utilizing appropriate ICD-10 coding methodology.
Use the current claim form to expedite claims processing. Acceptable claim forms are:
- CMS 1500.
- ADA 2012.
Regardless of the claim form utilized, claims are processed according to the appropriate fee schedule. New claims, medical records, correspondence and corrected claims should be submitted to:
P.O. Box 99011
Lubbock, TX 79490-9011
Please do not send medical records unless instructed to do so.
For faster service, and to save time and expense, dental providers should not send X-rays or molds with their claims or dental predeterminations unless request to do so.