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With the new TPA, providers might have noticed longer turnaround times as HealthChoice has moved more towards industry standard claim editing. Claims are still being processed within contractual provisions. Below are some helpful tips when it comes to the HealthChoice TPA:
While a procedure code may be listed on the fee schedule, all codes are subject to plan policies and provisions, including clinical editing and medical necessity guidelines. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement.