Electronic claims can be submitted through your claims clearinghouse by using payer ID number 71064. This number identifies HealthChoice as the claims administrator.
You may have made changes to your provider information that has not been reported to HealthChoice. Contact network management to verify your information or you can reference the Provider Self Service site and verify that the information in our records is correct. When information in the provider database is incorrect, it often causes claims to be pended or paid incorrectly.
If your claim was paid incorrectly because of an error made by HealthChoice, please contact the claims administrator toll-free at 800-323-4314 or TTY 800-545-8279.
Approximately 187,000 lives are covered under the HealthChoice plans. HealthChoice covers active and retired state, education and local government employees and their dependents.
Please contact certification administrator toll-free at 800-323-4314. HealthChoice requires that all non-emergency hospital admissions are certified at least three business days before the actual admission. Maternity admissions for delivery stays do not require certification.
Emergency admissions require notification within 24 hours (one business day) of the actual admission date. Holiday or weekend admissions must be certified by the next business day following the date of hospital confinement. The hospital, physician and the member will all receive notification verifying certification has been granted.
Please refer to the HealthChoice Network Provider Manual for more information.
Yes. 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 the member’s covered dependents:
- Are admitted to a hospital or are advised to enter a hospital.
- Require certain surgical procedures that are performed in an outpatient facility.
- Require certain diagnostic imaging procedures.
For more information, please refer to the HealthChoice Network Provider Manual.
Please provide us with a either a Network Provider Change Form or a Network Provider Additional Location Form. Please be sure to provide these forms prior to their effective date, or there will be a break in network coverage causing claims to deny or process as non-network. Be sure to include a new W-9.
Access to limited fee schedule information is available on the HealthChoice provider website. Use the following link to view the fee schedule. If you need further information regarding the fee schedule, please contact the HealthChoice Network Management Unit at 405-717-8970 or toll-free 844-804-2642 and a network management specialist will assist you.
You can print a copy of the appropriate change form online by selecting Provider Forms in the Provider drop-down menu. You can also contact HealthChoice Network Management and a change form will be sent to you. Please complete and return the change form as soon as possible using the fax number provided on the form. If you make a change to your TIN, please enclose an updated W-9 form as verification. When your change form is received, the provider database will be updated and your new information will be forwarded to the claims administrator. The HealthChoice Provider Contract requires that all changes be reported to HealthChoice within 15 days of the date of the change.
Claims and eligibility information are available online through the HealthChoice provider portal.
Please contact CVS/caremark at the following numbers and they will assist you in requesting authorization for a 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.