Surprise billing guidelines under the No Surprises Act
When a non-network provider submits a claim for emergency services, certain services at a network facility, or an air ambulance service, may be considered and processed as a surprise bill. To determine if your claim has processed as a surprise bill, review claim reason code descriptions at the end of the remittance.
The description will state:
This claim has been processed in accordance with applicable law. You cannot bill the patient for charges beyond the copay, deductible and/or coinsurance. If you disagree with the reimbursement amount, you may request negotiation with 30 days of receipt of payment in accordance with applicable law by emailing Network Management at EGID.Providers@omes.ok.gov or by calling toll-free 844-804-2642. Please refer to the Department of Labor Open Negotiation Notice for the instructions and form you can submit to EGID.
If you have questions regarding an NSA payment, please email HealthChoice Network Management at EGID.Providers@omes.ok.gov or call toll-free 844-804-2642.
Provider’s right to appeal
The HealthChoice internal appeals process grants providers the right to request a reconsideration of any adverse determination. You must submit your appeal in writing to the HealthChoice Appeals Unit at the address below within six months (or as required by law or your participation agreement) from the date of the original remittance advice. Claims can be appealed online using the HealthChoice provider portal or in writing. All applicable documentation along with written request for reconsideration must be submitted to:
HealthChoice Post-Service Appeals
P.O. Box 30546
Salt Lake City, UT 84130-0546
Any medical or dental certification request or claim denied in whole or in part can be appealed within 180 days from receipt of denial.
For more information on provider appeal rights, please call HealthChoice Customer Care toll-free at 800-323-4314. TTY users call 711.
Timely filing of medical and dental claims
Claims can be submitted electronically using payor ID 71064 or through the HealthChoice provider portal. Claims can be entered directly online through Availity or DentalXchange, or uploaded through PCH using the HealthChoice provider portal. All HealthChoice contracts contain timely filing provisions.
- Original claim submissions must be filed within 180 days from the date of service.
- Corrected claim submissions must be filed within 180 days from the original processed date.
- Secondary and tertiary claim submissions must be filed within 180 days from the previous responsible carrier’s processed date.
For additional information, please call EGID Network Management at 405-717-8790 or toll-free 844-804-2642.
This link provides access to the HealthChoice machine-readable file.