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Posted by 1406 on Tuesday - January 22, 2019

Your patients with HealthChoice primary coverage may be able to get certain imaging, cardiology or surgical procedures covered at 100 percent 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.

Posted by 1406 on Tuesday - January 22, 2019

When the provider who renders the service is different from the billing provider, the rendering provider information, including the individual provider’s NPI number, must be included on the claim. The rendering provider’s name and individual NPI number will help ensure that the claims administrator selects the correct network or non-network provider and applies benefits accordingly.

Posted by 1406 on Tuesday - December 4, 2018

EGID heard your concerns regarding transmitting faxed information to our Health Care Management Unit. We involved not only the local and long-distance carrier, but also the hardware manufacturer and our internal IT team to find a solution. This collaboration led EGID to procure new fax lines to be more compatible with the fax protocols in use today. Over the next several months, we will phase out the old numbers.

Posted by 1406 on Wednesday - October 24, 2018

HealthChoice is offering a new and unique benefit for all HealthChoice members. The focus of the program is to strengthen the relationship between a member and their physician. If there is no provider associated with a member, care management encourages the member to find the right primary care provider and assists the member in scheduling and keeping those appointments. The philosophy is that if that relationship is strong, the member will have better health outcomes.

Posted by 1406 on Wednesday - October 24, 2018

Some providers are submitting paper Medicare supplement claims in addition to electronic crossover claims.

Posted by 1406 on Wednesday - October 3, 2018

Final Ambulance Fee Schedule Methodology Effective Jan. 1, 2019

Posted by 1406 on Thursday - July 26, 2018

HealthChoice no longer accepts verification of other insurance submitted by the provider.  The member must complete the verification of other insurance process through the member portal at www.healthchoiceconnect.com or by calling the medical and dental claims administrator toll-free at 800-323-4314.

Posted by 1406 on Thursday - July 26, 2018

The Network News is the primary information source for HealthChoice Network Providers. The newsletter provides plan update information and notice requirements as set out in Section XI of the Network Provider Contracts.

Posted by 1406 on Friday - May 25, 2018

Final J1 Status Indicator Outpatient Fee Schedule Methodology

EGID will implement the full CMS J1 Status Indicator pricing (Option 2) on impacted claims for outpatient services for dates of service beginning Jan. 1, 2019.

Posted by 1406 on Wednesday - March 21, 2018

Effective Jan. 1, 2018, HealthChoice will increase the reimbursement rate in the policy for physician assistants, certified nurse practitioners, certified nurse midwives, and certified nurse specialists billing under their own NPIs within the scope of their license. The allowable will be calculated at 100 percent of the physician fee schedule rate for all services, other than professional services billed within CPT code range 90785-99999.

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