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Posted by 1406 on Friday - September 18, 2020

For all dates of service on or after Jan. 1, 2021, HealthChoice will reduce the allowable fee 25% for services billed with modifiers 52 (reduced services), 53 (discontinued procedure) and 73 (discontinued outpatient hospital/ASC). HealthChoice currently does not reduce the allowable fee.

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Posted by 1406 on Friday - September 18, 2020

CPT code 21248 is for partial restorations using implants involving less than half of the arch, while 21249 is for complete restorations involving more than half of the arch. Do not report these codes for each implant. Only report one instance of the applicable code, and report the number of implants placed in the “units” column.

Certification is required.

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Posted by 1406 on Friday - April 17, 2020

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.

Posted by 1406 on Friday - April 17, 2020

HealthChoice covers orthodontic services for members under the age of 19; and for members ages 19 and older with temporomandibular joint dysfunction. Certification is required through the HealthChoice Health Care Management Unit for members aged 19 and older.

Posted by 1406 on Friday - April 17, 2020

The HealthChoice certification list, updated quarterly, is available through the online HealthChoice fee schedule. Log in to view the most recent list.

Posted by 1406 on Wednesday - February 19, 2020

HealthChoice has implemented a benefit for coverage of the Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Programs (DPPs) and is 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 that help prevent type 2 diabetes.

Posted by 1406 on Monday - February 3, 2020

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

 

Posted by 1406 on Friday - January 31, 2020

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

Posted by 1406 on Friday - January 31, 2020

HealthChoice urges dental and behavioral health providers to report actual billed charges on claims and not the HealthChoice allowed charges. Billing the allowed charges can result in a misrepresentation of costs in this market. Artificially reducing your billed charges to represent contracted rates can affect statistics HealthChoice uses to determine allowed charges for services.

Posted by 1406 on Friday - January 31, 2020

The HealthChoice and Department of Corrections annual MS-DRG updates to acute inpatient reimbursement include updates to tier designations based on the number of beds and provider type designation as urban or rural as contained within the current final inpatient prospective payment system file.

For charges incurred on and after Oct. 1, 2019, the following changes are effective for the HealthChoice and DOC MS-DRG fee schedules:

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