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Frequently Asked Questions - Provider

You can print a copy of the appropriate change form online by selecting Provider Forms in the Provider drop-down menu. You can also contact HealthChoice Network Management and a change form will be sent to you. Please complete and return the change form as soon as possible using the fax number provided on the form. If you make a change to your TIN, please enclose an updated W-9 form as verification. When your change form is received, the provider database will be updated and your new information will be forwarded to the claims administrator. The HealthChoice Provider Contract requires that all changes be reported to HealthChoice within 15 days of the date of the change.

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Claims and eligibility information are available online through the HealthChoice provider portal, HealthChoice Connect, at www.healthchoiceconnect.com.

If you are unable to access the information using HealthChoice Connect, please contact the claims administrator toll-free at 800-323-4314 or TTY 800-545-8279.
 

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Generally, your application will take no more than 15 business days to process once we receive your completed application and supporting documentation. Your contract will become effective the day we process your application. You will receive written confirmation of the effective date via mail. If you would like to verify your effective date, you may do so through our provider self-service at gateway.sib.ok.gov/ProviderSelfService/.

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Please contact CVS/caremark at the following numbers and they will assist you in requesting authorization for a non-preferred medication.

SilverScript Plan Members 
To request a Part D prior authorization, contact CVS/caremark toll-free at 855-344-0930.

Current employees, Pre-Medicare Former Employees and Without Part D Plan Members 
To request a prior authorization, contact CVS/caremark toll-free at 800-294-5979.

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Please contact certification administrator toll-free at 800-323-4314. HealthChoice requires that all non-emergency hospital admissions are certified at least three working days before the actual admission. Maternity admissions for delivery stays do not require certification.

Emergency admissions require notification within 24 hours (one business day) of the actual admission date. Holiday or weekend admissions must be certified by the next business day following the date of hospital confinement. The hospital, physician and the member will all receive notification verifying certification has been granted.

Please refer to the HealthChoice Network Provider Manual for more information.

Or, you can begin the certification process by completing the online certification found at https://hcok.urcertification.com.

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Yes. Certification is required for certain outpatient surgical and diagnostic imaging procedures. 

Certification is a review process used to determine if certain services are medically necessary according to HealthChoice guidelines. Certification is performed by either the HealthChoice certification administrator or by the HealthChoice Health Care Management Unit, depending on the type of service.

The provider must obtain certification under certain situations, including when the member or the member’s covered dependents: 

  • Are admitted to a hospital or are advised to enter a hospital.
  • Require certain surgical procedures that are performed in an outpatient facility.
  • Require certain diagnostic imaging procedures.

For more information, please refer to the HealthChoice Network Provider Manual.

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The claims administrator administers all health, dental and life claims on behalf of HealthChoice. Submit paper claims, correspondence and medical records to:

HealthChoice
P.O. Box 99011
Lubbock, TX 79490-9011

Submit appeals and provider inquiries to:

HealthChoice
P.O. Box 3897
Little Rock, AR 72203-3897

To ensure timely claims processing, the following information must be included on a CMS-1500, UB-04, or ADA form:

Patient’s name
Primary insured’s name
Primary insured’s ID number
Provider’s name and tax ID number
Provider’s billing address
Date(s) of service
ICD or DSM diagnosis codes
CPT/HCPCS, DRG, CDT, or ASA codes with the appropriate modifiers

Itemized charges are required for all outpatient hospital services. Forms must be completed as required by CMS guidelines.

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Providers can appeal a claim 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.

Appeals and Provider Inquires
HealthChoice
P.O. Box 3897
Little Rock, AR 72203-3897

Second level appeals are available only to participating network providers and should include any additional documentation if available.
 

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To request certification, print a copy of the applicable certification form. Please complete the form and fax it directly to the HealthChoice Health Care Management Unit. To access the following certification forms, follow the links below:

SilverScript Plan Members 
To request a Part D prior authorization, contact CVS/caremark toll-free at 855-344-0930.

Current employees, Pre-Medicare Former Employees and Without Part D Plan Members 
To request a prior authorization, contact CVS/caremark toll-free at 800-294-5979.

Please refer to the HealthChoice Network Provider Manual for more information.

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Effective Jan. 1, 2018, HealthChoice is partnering with ECHO Health, a payment disbursement service, to provide support for EFT and ERA processes.

EFTs and clearinghouse ERA delivery preferences for dates of service in 2018 will be maintained by ECHO Health.

HealthChoice encourages providers and facilities to reach out to ECHO Health Customer Service toll-free at 844-586-7463 if your organization:

  • Does not currently have access to ECHO Health’s provider portal, www.providerpayments.com.
  • Would like to automate the ERA delivery through your preferred clearinghouse partner. Please note that if existing clearinghouse routing is in place, this will be maintained.

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Please provide us with a either a Network Provider Change Form or a Network Provider Additional Location Form. Please be sure to provide these forms prior to their effective date, or there will be a break in network coverage causing claims to deny or process as non-network.  Be sure to include a new W-9.

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Access to limited fee schedule information is available on the HealthChoice provider website. Use the following link to view the fee schedule. If you need further information regarding the fee schedule, please contact the HealthChoice Network Management Unit at 405-717-8970 or toll-free 844-804-2642 and a network management specialist will assist you.

HealthChoice Fee Schedule Search

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Approximately 187,000 lives are covered under the HealthChoice Plans. HealthChoice covers active and retired state, education and local government employees and their dependents.

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You may have made changes to your provider information that has not been reported to HealthChoice. Contact network management to verify your information or you can reference the Provider Self Service site and verify that the information in our records is correct. When information in the provider database is incorrect, it often causes claims to be pended or paid incorrectly.

If your claim was paid incorrectly because of an error made by HealthChoice, please contact the claims administrator toll-free at 800-323-4314 or TTY 800-545-8279.

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Electronic claims can be submitted through your claims clearinghouse by using payer ID number 71064. This number identifies HealthChoice as the claims administrator.

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