In February, EGID welcomed Yasmine Barve as its new director of network management. A registered nurse and certified professional coder, Yasmine has over 27 years of experience in insurance and public service. We are excited to have Yasmine join the network management team, which consistently provides excellent provider service in areas such as contracting and provider support.
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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.
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.
The HealthChoice certification list, updated quarterly, is available through the online HealthChoice fee schedule. Log in to view the most recent list.
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.
Future fee schedule updates for services provided by HealthChoice network providers are scheduled for:
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.
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.
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:
As a reminder, HealthChoice does not cover dental services under the health plan. HealthChoice does allow exceptions in cases of traumatic accidents, congenital disorders or complications resulting from cancer. In these cases, certification is required through the HealthChoice Health Care Management Unit (HCMU).
For additional information regarding certification, please contact HCMU toll-free at 800-543-6044, ext. 8879. TTY users call 711.