Medical Records Requests

Posted 07/14/2017

In an effort to decrease the claims administration turnaround time, the medical and dental claims administrator for HealthChoice, the Department of Corrections and the Department of Rehabilitation Services requires a scan sheet be attached to all medical or dental records submitted. This requirement is to facilitate quickly matching the records with the correct claim. If records are submitted without the scan sheet, they will be returned to you. Please do not submit records unless they are requested by the claims administrator. This scan sheet and instructions for completion are available on our website. A separate scan sheet must be completed for each claim for which you are submitting records.

The form and instructions are available on our website at https://www.ok.gov/sib/Providers/Medical_Records_Requests/index.html.

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

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Provider Phone Inquiries

Posted 07/14/2017

In an effort to better serve our providers, the claims administrator has added additional phone prompts to the HealthChoice local and toll-free numbers. The additional prompts include options for the Department of Rehabilitation Services and the Department of Corrections.

The claims administrator is the first point of contact for all eligibility, benefits, claim inquiries, 1099 inquiries, etc. Network management is the first point of contact for any contract inquiries.

If you need additional assistance after speaking with the claims administrator, you can call network management. When calling network management, have the call reference number and the name of the claims representative who assisted you. If you do not have this, we will ask that you call the claims administrator again for assistance.

If you have any questions, please contact network management.

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Changes to Remittance Advices and ClaimLink

Posted 01/20/2016

Maintaining confidentiality is especially important to patients seeking treatment for sensitive issues and improvements in our privacy processes are made on an ongoing basis.

In order to better maintain patient confidentiality, HealthChoice, the Department of Rehabilitation Services and the Department of Corrections will remove the “Code” header and the “Code Description” from “Remittance Advices” and “ClaimLink” for all claims processed on or after Jan. 1, 2016. The certification administrator will also remove all references to coding/description from all communications.

For additional information, please contact the medical and dental claims administrator, refer to “Network Provider Contact Information”.

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Claims that Contain Both ICD-9 and ICD-10 Diagnosis Codes

Posted 01/20/2016

HealthChoice, the Department of Rehabilitation Services and the Department of Corrections have adopted the Centers for Medicare & Medicaid Services (CMS) guidelines for handling claims for charges incurred prior to Oct. 1, and after Oct. 1, 2015. Providers and facilities cannot submit one claim with charges incurred prior to Oct. 1, and charges incurred on or after Oct. 1. Failure to follow CMS guidelines will result in either your clearinghouse rejecting your claim or our claims administrator denying your claim. For specific claim filing guidelines, please visit the CMS website at www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/SE1408.pdf.

If you have any questions, please contact our medical claims administrator. Refer to “Network Provider Contact Information”.

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Modifier 59 Clinical Editing Changes

Posted 10/30/2015

For charges incurred on or after Jan. 1, 2016, clinical editing for modifier 59 will be applied with the appropriate modifiers. These modifiers are used only for tracking and reporting purposes.

  • 59 – Distinct Procedural Service
  • PO – Surgeries, procedures and/or surgeries provided at off-campus provider-based outpatient departments
  • XE – Separate encounter, a service that is distinct because it occurred during a separate encounter
  • XP – Separate practitioner, a service that is distinct because it was performed by a different practitioner
  • XS – Separate structure, a service that is distinct because it was performed on a separate organ/structure
  • XU – Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

Network providers can model clinical editing through “ClaimLink.” Go to www.healthchoiceok.com/Providers and select “ClaimLink.”

For more information or if you have questions regarding this change, please contact the medical and dental claims administrator, refer to “Network Provider Contact Information”.

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ICD-10 Quick Start Guide

Posted 10/30/2015

An ICD-10 “Quick Start Guide” has been posted to the “ClaimLink” portal. The “Quick Start Guide” gives step-by-step instructions for entering claims with ICD-10 diagnosis codes using “ClaimLink,” and includes screen shots to help guide you through the process. For additional information, please visit our website at www.healthchoiceok.com and select “ClaimLink” in the top menu bar and then select “ClaimLink for Providers.”

If you have questions regarding this change, please contact our medical and dental claims administrator, refer to “Network Provider Contact Information”.

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Social Media Presence

Posted 10/30/2015

We are happy to announce that the Office of Management and Enterprise Services (OMES), the parent agency of the Employees Group Insurance Department, has launched a Facebook page and a Twitter profile as a new avenue to keep everyone informed of OMES events, accomplishments and new products.

Please follow us on Facebook at www.facebook.com/OklahomaOMES, and on Twitter at twitter.com/OklahomaOMES.

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Receive Your Remittance Advices Electronically

Posted 07/27/2015

An electronic remittance advice (ERA) is an electronic version of your explanation of payment. It contains the same details as the paper version you normally receive. Receiving ERAs can provide numerous benefits to any medical practice, such as:

  • Quick, easy receivables reconciliation;
  • Less time spent opening mail, filing, and making phone calls to health insurers;
  • Elimination of paper remittances;
  • Fast turnaround for claims to secondary payers; and
  • More time to focus on revenue-enhancing functions.

If you would like more information about ERAs, please contact network management at 1-405-717-8790 or toll-free 1-844-804-2642, or send email inquiries to EGID.NetworkManagement@omes.ok.gov

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Attention All Providers 1099

Posted 10/30/2015

Providers will receive one 1099 for each tax identification number (TIN). If you share a TIN with other providers, there will still be only one 1099 sent. This form will be addressed to the name registered with the Internal Revenue Service and mailed to the address indicated on your W-9 form.

If you have questions regarding this change, please contact our medical and dental claims administrator, refer to “Network Provider Contact Information”.

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UB-04 Updates

Posted 10/30/2015

HealthChoice, the Department of Corrections and the Department of Rehabilitation Services will recognize the NUBC approved qualifiers “9” and “0” to denote which revision of ICD codes are required to be reported on claims. Using form locator 66 on the UB-04 form, “9” designates the use of ICD-9 codes and “0” designates the use of ICD-10 codes. For all claims incurred on or after Oct. 1, 2015, ICD-10 codes are required. The new UB-04 billing guide is available on our website at www.healthchoiceok.com/Providers.

If you have questions regarding this change, please contact the medical and dental claims administrator, refer to “Network Provider Contact Information”.

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Submit Only Current Network Provider Contracts

Posted 10/30/2015

Please be sure you submit only the most recent versions of the HealthChoice, Department of Rehabilitation Services (DRS) or Department of Corrections (DOC) contracts. Outdated contracts will be returned to the provider which will delay the processing of the provider’s Network contract. The most current versions are always available online at the website addresses listed below.

HealthChoice contracts are available at www.ok.gov/sib/Providers/Contracts_and_Applications.

DRS Contracts are available at gateway.sib.ok.gov/DRS/Contracts.aspx.

DOC Contracts are available at gateway.sib.ok.gov/DOC/Contracts.aspx.

If you have any questions or are unsure which contract to use, contact network management, refer to “Network Provider Contact Information”. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov.

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New Clearinghouse for Dental Providers

Posted 07/27/2015

HealthChoice, the Department of Rehabilitation Services and the Department of Corrections are now working with DentalXChange, a clearinghouse for dental providers, for the submission of electronic claims and receipt of electronic remittance advices (ERAs).

For additional information or to sign up for electronic claims submission and ERAs, please visit our website at www.healthchoiceok.com or contact network management at 1-405-717-8790 or toll-free 1-844-804-2642. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov

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Quick Tips for Submitting Claims

Posted 07/27/2015

For the fastest claims processing, submit claims electronically or through ClaimLink.

If you consistently have issues with claims that do not process quickly, please verify the format your intermediary or clearinghouse uses to submit your claims. Make sure they are filing your claims electronically and not on paper because it takes much longer to process paper claims.

Use the current claim form to expedite claims processing. Accepted claim forms include the ADA 2012*, CMS 1500 (02-12) and UB-04.

If we request additional documentation to process a claim or if you need to file a corrected claim, please submit the information or corrected claim to:

  • HP Administrative Services, LLC
  • P.O. Box 24110
  • Oklahoma City, OK 73124-0110

When you submit a claim electronically and then submit a duplicate paper claim, it can significantly slow down your payment. If you submit a claim and need to verify payment, please contact our health and dental claims administrator or log in to "ClaimLink" to check the claim status. Resubmit a claim only if it is not already on file. When the same claim is submitted multiple times, each additional claim can deny as a duplicate and further delay the adjudication process.

If you have questions, please do not hesitate to contact our medical and dental claims administrator at 1-405-416-1800 or toll-free 1-800-782-5218.

*Dental providers: For faster service and to save time and expense, please do not send dental X-rays or molds with your claims or dental predeterminations unless they are requested by HealthChoice.

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DRS Fee Schedule Update Effective June 30

Posted 07/02/2015

The Department of Rehabilitation Services has updated its fee schedule for charges incurred on or after June 30, 2015.

If you have any questions, please contact network management at 1-405-717-8921, toll-free 1-888-835-6919, or send email inquiries to EGID.DRSNetworkManagement@omes.ok.gov.

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ICD-10 Testing

Posted 05/26/2015

Testing is crucial to the successful implementation of ICD-10 codes for all charges incurred on and after Oct. 1, 2015.

Please submit your test claims as soon as possible to prevent any delays in the accurate and timely processing of your claims. We strongly recommend you send your test claims now so any claims processing issues can be identified and resolved before the Oct. 1 deadline.

Contact your clearinghouse to begin the ICD-10 testing process. You can test directly with Emdeon Business Services LLC® Testing Exchange, Nuesoft Technologies, Inc., or DentalXChange. If you use a different clearinghouse, please contact them and ask them to work directly with one of these companies.

For additional information or to begin the ICD-10 code testing process, please contact the network management unit at 1-405-717-8790 or toll-free 1-844-804-2642. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov.

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Electronic Remittance Advice (835 transaction) Update

Posted 05/19/2015

HP Administrative Services, LLC (HP) reviewed the mappings of all proprietary Explanation Codes reported on Remittance Advices. This review included Claim Adjustment Group Codes, Claim Adjustment Reason Codes and Remittance Advice Remark Codes reported on 835 transactions. Some of the mappings did not accurately reflect the outcomes of claims adjudications or did not provide enough information regarding the outcomes of claims adjudications so providers could take action on claims.

HP has corrected this error. Providers who have received 835 transactions and have issues with the reason codes provided can use “ClaimLink” to view Remittance Advices. Providers can also request an extension of the dual delivery of Remittance Advices with 835s by calling customer service at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.

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Always Get the Most Current Fee Schedule Information

Posted 01/23/2015

In order to guarantee that you are viewing the most current fee schedule information on our website, be sure to refresh your screen.

For Internet Explorer users, simply press while on our fee schedule webpage.

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HealthChoice and HP Complete Phase III CORE Certification

Posted 01/23/2015

The Employees Group Insurance Division of the Office of Management and Enterprise Services is pleased to announced that HealthChoice and HP Administrative Services, LLC (HP) have achieved CAQH® Committee on Operating Rules and Information Exchange (CORE®) Phase III Certification.

CAQH is a non-profit alliance of health plans and trade associations that are committed to the development and adoption of national operating rules for coverage-related administrative transactions. Its mission is to promote quality interactions between plans, providers and other stakeholders, reduce costs associated with healthcare administration, facilitate the exchange of administrative healthcare information and to encourage the integration of administrative and clinical data.

CORE Phase III certification ensures healthcare organizations and providers can electronically exchange and access patient coverage information with HealthChoice and HP according to CORE rules. Regardless of the technology, CORE rules are based on national standards, including HIPAA, which make the transmission of electronic data progressively more streamlined, seamless and predictable.

Now that HealthChoice and HP have achieved CORE certification, HealthChoice providers have the ability to electronically access consistent and accurate administrative data, such as eligibility, benefits, claims’ status and coverage information which will help to eliminate phone calls and paperwork for the office staffs of our providers.

CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved.

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ClaimLink for Providers

Posted 09/08/2014

Network Providers have access to ClaimLink, our powerful, secure website designed to quickly enter claims, request dental predeterminations, check eligibility, check claims status and obtain electronic remittance advices. Visit our website at www.healthchoiceok.com and click on ClaimLink - Providers. Registration is quick, easy, and secure.

Network Providers who use ClaimLink to enter claims for services or dental predeterminations will generally receive a response the next business day. Online claims submission is a much more efficient method of submitting claims. It significantly reduces processing errors and improves the turnaround times for claims payments. A presentation that outlines the online claims submission process is available once you log into the application.

If you have questions regarding ClaimLink or need assistance registering, please contact our health and dental claims administrator at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.

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Tips for Claims Submissions

Posted 07/21/2014

When you submit claims electronically and then resubmit a paper claim, it can significantly slow down your payments. If you submitted a claim and need to verify payment, please contact our health and dental claims administrator or log in to ClaimLink to check the claim status. Resubmit the claim only if it is not already on file. When you submit the same claim multiple times, each additional claim can deny as a duplicate and further delay the adjudication process of other claims.

  • Submit claims electronically or through ClaimLink for quickest processing.
  • If you consistently have issues with claims not processing timely, please verify the format that your intermediary or clearinghouse uses to submit your claims. Make sure they file your claims electronically and don’t drop them to paper.
  • Use the most current claim form to expedite the process: ADA 2012, CMS 1500 (02-12) or UB-04.
  • Dental providers: For faster service and to save time and expense, please do not send dental x-rays or molds with your claims or dental pre-determinations unless they are requested.
  • If we request additional documentation to process a claim or if you need to file a corrected claim, please mail to:

    • HP Administrative Services, LLC
    • P.O. Box 24110
    • Oklahoma City, OK 73124-0110

Please remember you can log in to ClaimLink by selecting ClaimLink above.

If you have further questions, please do not hesitate to contact our health and dental claims administrator by calling 1-405-416-1800 or toll-free 1-800-782-5218.

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