Provider Archived Articles

Dental Fee Schedule Update

Posted 10/25/2017

The HealthChoice dental fee schedule was updated on July 1, 2017, to allow ADA codes D0364-D0369 and D0380-D0385 under the health benefit. These codes were previously listed in error as non-covered on the dental fee schedule. This retro update is effective beginning with dates of service Jan. 1, 2017. Dental providers do not need to resubmit claims. If claims were previously denied in error, HealthChoice will automatically adjust these claims.

If you have questions, call the dental claims administrator. Refer to Network Provider Contact Information at the end of this newsletter.

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HealthChoice Select Bilateral Procedures

Posted 10/25/2017

Effective Oct. 1, 2017, HealthChoice Select can reimburse bilateral procedures at 150 percent of the Select allowable fee when a bilateral modifier is billed on the claim. Appropriate modifiers include:

  • Bilateral modifier 50 billed on any code within the claim.
  • Both an LT and RT modifier billed on the same claim.
  • RC and LC or RC and LM modifier billed on any codes within the claim.
  • E1 or E2 and E3 or E4 modifiers billed on any codes within the claim.
  • FA or F1-F4 and F5-F9 on any codes within the claim.
  • TA or T1-T4 and T5-T9 on any codes within the claim.

Only one bilateral encounter will be reimbursed per claim.

If you have questions, please contact the medical claims administrator.

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HealthChoice Select Implants

Posted 10/25/2017

For charges incurred on or after July 1, 2017, EGID updated the HealthChoice and the Department of Corrections Select Facility and Ambulatory Surgery Center addendums to require participating facilities to bill covered implants at invoice costs, less any rebates and or discounts received by the facility for all Select services. For charges incurred on or after April 1, 2017, HealthChoice and the Department of Corrections no longer reimburse implants separately on Select inpatient claims as they are inclusive of the MS-DRG.

For more information, please refer to the HealthChoice Select Facility Amendment at https://www.ok.gov/sib/documents/HCSelectASCAmendment.pdf.

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W-9 Forms

Posted 10/25/2017

According to the Internal Revenue Service, the tax identification number, name and address on the W-9 must match the SS4 letter you received from the IRS confirming your TIN. Only one W-9 that applies to all providers who share the TIN should be prepared and sent. The W-9 can only contain one address. A physical address and a mailing address are not to be reported or the W-9 will be returned and backup withholding could occur.

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Oct. 1, 2017, Fee Schedule Update Notice

Posted 07/27/2017

For charges incurred on or after Oct. 1, 2017, HealthChoice and the Department of Corrections (DOC) will make comprehensive updates to the following fee schedules: MS-DRG and MS-DRG LTCH, quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, outpatient facility (OP), ambulatory surgery center (ASC), the American Society of Anesthesiologists (ASA), the American Dental Association (ADA), and Select inpatient and outpatient. Rates for the outpatient procedures covered under the HealthChoice and DOC Select programs that became effective July 1, 2017, will be fully phased in beginning Oct. 1, 2017.

Inpatient and outpatient tier designations are updated annually on Oct. 1 based on the most current CMS fiscal year inpatient prospective payment system (IPPS) impact file for network providers.

Additional Fee Schedule Updates

  • For charges incurred on or after July 1, 2017, HealthChoice and DOC made comprehensive updates to the following fee schedules: CPT/ HCPCS, OP, ASC, ADA, and Select inpatient and outpatient.

As a reminder, the American Medical Association periodically changes, adds, corrects and/or deletes procedure codes throughout the year. When these changes occur, HealthChoice and DOC review them as soon as possible and make any necessary changes. Additionally, HealthChoice and DOC make fee schedule updates on an ad hoc basis when necessary.

Fee schedule updates are reported in each issue of the Network News which is distributed quarterly to all network providers. Updates are also posted to the provider websites. We encourage you and your staff to reference the website of your provider network for the most recent fee schedule updates and other important information.

If you have questions, please contact network management. Refer to Network Provider Contact Information at the end of this newsletter. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov or EGID.DOCNetworkManagement@omes.ok.gov.

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Select Fee Schedule Update

Posted 07/14/2017

Effective with the April 1, 2017, fee schedule updates, HealthChoice made some changes to the appearance of the fee schedule. These updates are now housed within the full file and not listed separately on the addendum file. The full file now contains an add/change/delete column and certification column. The add/change/delete column indicates the changes that occurred from the most recent or previous file update to the current file. Refer to the legend below for examples of what you might see in the add/change/delete column fields.

The certification column indicates a C if a certification for that code is needed. If it is blank, certification is not required. All other fields on the fee schedule remain as they are currently.

If you have questions, please contact network management. For questions about certification, contact the certification adminstrator.

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Be Part of the HealthChoice Select Program

Posted 07/15/2016

HealthChoice would like your facility to be part of the HealthChoice Select Program. HealthChoice Select is a program designed to reduce the costs of select services by contracting with select medical facilities to provide these services and bill HealthChoice for a single amount for all costs associated with the service on the date the surgery or procedure is performed.

Effective July 1, 2016, HealthChoice once again expanded the services covered under the Select program to include more of those with reasonably controllable cost variances, high consumer demand, and market growth.

Advantages of participating in the HealthChoice Select Program include:

  • Procedures covered at 100 percent of Allowable Fees;
  • No copays, coinsurance and/or deductibles to collect;
  • Approximately 170,000 HealthChoice members in or near Oklahoma;
  • Potential to increase patient volume;
  • Dedicated provider directory on HealthChoice website; and
  • Targeted marketing to HealthChoice members.

Visit the web page at https://gateway.sib.ok.gov/providersearch/SelectProgram.aspx for a full list of the services available under HealthChoice Select. Be aware that participating facilities are not required to provide all of the services covered under the program. Facilities can choose any combination of services and opt-in or opt-out at any time, according to existing contract notification provisions.

For more information about participating in HealthChoice Select, please contact network management. Refer to “Network Provider Contact Information” on the back page. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov.

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