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Frequently asked questions

Electronic claims can be submitted through your claims clearinghouse by using payer ID number 71064. This number identifies HealthChoice as the claims administrator.

Approximately 187,000 lives are covered under the HealthChoice plans. HealthChoice covers active and retired state, education and local government employees and their dependents.

When certification is not initiated and approved within the time frames described below, a 10% penalty is applied, if approved retrospectively. The member is not responsible for this penalty.

Certification is required within three business days prior to scheduled hospital admissions, certain surgical procedures in an outpatient facility and certain diagnostic imaging procedures. Certification is required within one day following emergency/urgent services.

Additional information about certification is on the HealthChoice Provider site.

For questions about certification, call the Customer Care team at toll-free 800-323-4314. TTY users call 711.

Certification is required for certain outpatient surgical and diagnostic imaging procedures.

Certification is a review process used to determine if certain services are medically necessary according to HealthChoice guidelines.

The provider must obtain certification under certain situations, including when the member or member’s covered dependents:

  • Are admitted to a hospital or advised to enter a hospital.
  • Require certain surgical procedures that are performed in an outpatient facility.
  • Require certain diagnostic imaging procedures.

For more information, login to the fee schedule portal to view the certification requirements listed on each fee schedule.

Please submit a Network Provider Change Form or a Network Provider Additional Location Form along with a W9. If you are changing TIN’s you will need to complete a new HealthChoice Contract and Application. The HealthChoice contracts require that all changes be reported to HealthChoice 15 days prior to the change.

Documents and forms should be sent to EGID Network Management. Once your information has been received, it will be reviewed by a member of EGID Network Management and then updated to reflect in the Provider Search site.

Access to fee schedules is limited to HealthChoice Network Providers. If you need further information regarding the fee schedule, contact EGID Network Management at toll-free 844-804-2642.

HealthChoice Fee Schedule Login

Eligibility, benefit and claim information is available online through the HealthChoice Provider Portal or through the automated IVR system at toll-free 800-323-4314. TTY users call 711.

Please contact CVS/caremark at the following numbers and they will assist you in requesting authorization for non-preferred medication.

SilverScript Plan Members
To request a Part D prior authorization, contact CVS/caremark toll-free at 855-344-0930.

Current employees, Pre-Medicare Former Employees and Without Part D Plan Members
To request a prior authorization, contact CVS/caremark toll-free at 800-294-5979.

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