Network news

              #2568
Network News Fall Edition 2011
Oklahoma State and Education Employees Group Insurance Board
A Division of the Office of State Finance
New! High and Basic Alternative Plans
He lthChoice Provider
For additional updates and articles, visit the Network Provider
websites. HealthChoice Providers use www.sib.ok.gov or www.
healthchoiceok.com. DOC Providers use https://gateway.sib.
ok.gov/DOC. DRS Providers use https://gateway.sib.ok.gov/DRS.
Each year, tobacco use costs
the HealthChoice health plans
and their members approximately
$52 million. Because these costs
impact all health plan premiums,
on January 1, 2012, HealthChoice
is introducing the High and Basic
Alternative Plans for tobacco
users. Providers need to be aware
that the individual deductibles and
out-of-pocket limits for these two
plans are each $250 higher than
the HealthChoice High and Basic
Plans.
During Option Period, primary
members will be required to
complete and submit an Attestation
stating they and their covered
family members are tobacco-free.
Members who do not or
cannot complete the tobacco-free
Attestation will automatically be
enrolled in an Alternative plan.
Members and dependents that
use tobacco can remain in the
High or Basic Plans, which have
lower out-of-pocket costs, by
providing a letter confirming their
enrollment in, or completion of,
the HealthChoice tobacco cessation
program offered through the
Oklahoma Tobacco Help Line at
1-800-Quit-Now.
Currently, HealthChoice
benefits include $5 copays for
certain prescription tobacco
cessation medications, free over-the-
counter (OTC) nicotine
replacement therapy products, and
up to five free telephone-coaching
sessions. OTC products include
lozenges, patches, and gum.
Please Note!! Beginning
January 1, 2012, HealthChoice
will eliminate the $5 copay for
prescription products, so the entire
quit tobacco program will be free
to our members.
HealthChoice is committed
to helping our members become
healthier by removing the cost
barriers associated with some
quit tobacco programs. It is our
hope that our members will take
advantage of these benefits and
become tobacco free!
Please direct email inquiries
to oseegibproviderrelations@
sib.ok.gov or contact Provider
Relations. See Network Provider
Contact Information on the back
page.
Each year, HP Administrative
Services, LLC (HP), the health
and dental claims administrator for
HealthChoice, sends 1099 forms
to all providers who had claims
paid by the Plan. These forms
are prepared using identification
information submitted by providers
on Form W-9. This information
must match the information on
file with the IRS. When records
do not match as required by the
IRS, HP must apply 28% backup
withholding to future claim
payments.
Each October, HP sends letters
requesting updated W-9 forms
from providers whose information
is not current. If you are asked
to update your Form W-9, please
make certain that the following
information matches IRS records:
• Corporate Name
• Address
• Tax Identification Number
(TIN)
Your TIN must match the
number listed on your Form SS4.
We hope this reminder will
help you avoid backup
withholding. If you
have questions or need
further information,
please contact HP
Administrative
Services, LLC. See
Network Provider Contact
Information on the back page.
Avoid Backup
Withholding!
Introducing Maintenance Network Pharmacies
2
H.E.L.P. 4 Wellness Initiative Continues in 2012
Effective January 1, 2012,
for all non-Medicare members,
HealthChoice is introducing
a new Maintenance Network
benefit for long-term, maintenance
medications. The Maintenance
Network includes both retail and
mail-service pharmacies.
Currently, CVS, Walmart, and
Sam’s Club pharmacies, as well as
the Medco pharmacy specializing
in mail service, are included
in the Maintenance Network.
Additionally, recruiting of local,
retail pharmacies throughout
Oklahoma continues. HealthChoice
members will be able to purchase
their maintenance medications
cheaper through any of the
Maintenance Network pharmacies.
When long-term, maintenance
medications are purchased through
any of the Maintenance Network
pharmacies, a 90-day supply
of medication will be available
for one copay; however, when
maintenance medications are
purchased at a pharmacy other than
a Maintenance Network pharmacy,
only a 30-day supply of medication
will be available for one copay.
If retail pharmacies in your
area do not become Maintenance
Network pharmacies, members are
assured access to a Maintenance
Network pharmacy because
Medco’s mail service pharmacy is
available to all members. It’s also
important to note that members’
benefits for short-term medications
will not be affected, regardless of
where they are purchased.
When prescribing for
HealthChoice members,
prescriptions for long-term,
maintenance medications should be
written for a 90-day supply. When
appropriate, providers should
indicate refills are available for up
to one year. We anticipate that our
providers will receive increased
calls from HealthChoice members
requesting new prescriptions
for maintenance medications so
they can take advantage of the
cost savings available through
Maintenance Network pharmacies.
To view a summary list of long-term,
maintenance medications,
visit www.healthchoiceok.com or
www.sib.ok.gov or contact Medco
toll-free at 1-800-903-8113.
Please direct email inquiries
to oseegibproviderrelations@
sib.ok.gov.
See Network
Provider Contact
Information on
the back page.
HealthChoice will continue
its H.E.L.P. 4 (Help Check)
wellness initiative in 2012.
H.E.L.P. 4 combines an online,
interactive health risk assessment
with the results of certain free
preventive services to provide
our members with personalized
health information as well as the
steps they need to take to improve
their health. Primary health plan
members who complete the
requirements of the H.E.L.P. 4
initiative receive a $100 incentive
payment from HealthChoice. The
program is available to all primary
non-Medicare plan members age
20 and older.
HealthChoice Provider
Relations is meeting with our
Network Providers to help
familiarize them with the wellness
initiative and free preventive
services offered by HealthChoice.
These meetings provide specific
details about the free preventive
services and the appropriate codes
to bill for 100% reimbursement
of Allowed Charges. Additional
information regarding the
HealthChoice provider website,
ClaimLink, and other upcoming
initiatives will also be discussed.
We hope our Network
Providers will take advantage of
this opportunity and schedule one
of these informative meetings.
The meetings are conducted by
Teresa South, Director of Provider
Relations, and Cassie Waters,
Director of Plan Benefits and
Health Promotion. To schedule a
meeting, contact Teresa South at
1-405-717-8627 or toll-free 1-800-
543-6044, ext. 8627. You can also
email Teresa at tsouth@sib.ok.gov.
Please direct email inquiries
to oseegibproviderrelations@
sib.ok.gov or contact Provider
Relations. See Network Provider
Contact Information on the back
page.
CPT Code Modifier 33, Preventive Service Updated!
Effective for charges incurred on or after January 1, 2012, HealthChoice and Department of Corrections
(DOC) Network Providers will be reimbursed 100% of Allowed Charges for the following evaluation and
management codes when they are billed using Modifier 33 to identify them as preventive services:
CPT Codes Description
99201 Office or other outpatient visit
99202 Office or other outpatient visit
99203 Office or other outpatient visit
99204 Office or other outpatient visit
99205 Office or other outpatient visit
99211 Office or other outpatient visit
99212 Office or other outpatient visit
99213 Office or other outpatient visit
99214 Office or other outpatient visit
99215 Office or other outpatient visit
Be aware that CPT Code Modifier 33 applies only to services provided to pre-Medicare patients.
Additionally, Modifier 33 should not be used for services that are already identified as preventive.
Questions should be directed to HP Administrative Services, LLC at 1-405-416-1800 or toll-free 1-800-782-
5218.
3
New Benefits for Preventive Services
Effective January 1, 2012, HealthChoice will adopt new benefits for preventive services. This means certain
preventive procedures will be covered at 100% of Allowed Charges for our members who meet the clinical
criteria when using a HealthChoice Network Provider.* Following is a list of some of the services that will be
free to eligible members:
♦♦ Blood pressure, diabetes, and cholesterol tests
♦♦ Breast, cervical, prostate, and colorectal cancer screenings
♦♦ Osteoporosis screening
♦♦ Counseling from health care providers on topics including quitting tobacco, losing weight, eating
healthy, treating depression, and reducing alcohol use
♦♦ Prescription tobacco cessation products
♦♦ Vaccines for children and adults
♦♦ Flu and pneumonia shots
♦♦ Screening for obesity and counseling by a doctor and other health professionals to promote sustained
weight loss, including dietary counseling from a doctor
♦♦ Screening for conditions that can harm pregnant women or their babies, including iron deficiency,
hepatitis B, a pregnancy related immune condition called Rh incompatibility, and a bacterial infection
called bacteriuria
♦♦ Special, pregnancy-tailored counseling from a doctor to help pregnant women quit smoking and avoid
alcohol use
♦♦ Counseling to support breast-feeding and help nursing mothers
Additional information on this subject is available on the provider website at www.sib.ok.gov/providers.
*When using a non-Network provider, these services will be covered according to Plan benefits.
4
Providers Should Test Claims for HIPAA 5010 Compliance
Beginning January 1, 2012,
all health/dental plans, claims
clearinghouses, and health/
dental providers must use new
standards for electronic healthcare
transactions. These new standards,
known as HIPAA 5010, will impact
claims, claims status requests, and
eligibility requests and responses.
The purpose of these
new standards is to provide
precise instructions and reduce
unnecessary information; however,
the new standards also require that
certain information be recorded
differently. As an example, under
HIPAA 5010 guidelines, the billing
address, Loop 2010AA, can no
longer be reported as a post office
box or lockbox address.
OSEEGIB previously requested
that all Network Providers who
bill on an 837P or 837D submit the
“Pay to or Remit Address” in loop
2010AA. Under the new HIPAA
5010 guidelines, providers who bill
using an 837P or 837D will need
to submit their “Pay to or Remit
Address” in loop 2010AB.
Network Providers will
continue to receive Remittance
Advices at their contracted “billing/
remit/pay to address”; however,
providers with multiple “billing/
pay to” addresses associated
with the same TIN/NPI could
have claim documents sent to the
address associated with the first
Network contract identified for the
provider. Providers that want to
receive claim payments/documents
at multiple “billing/remit/pay to”
addresses must submit a separate
TIN for each separate “billing/
remit/pay to” address.
Emdeon, the claims clearing
house for HP Administrative
Services, LLC, began accepting
test claims for 5010 compliance in
the third week of October, 2011.
Providers are strongly urged to test
claims for HIPAA 5010 compliance
and may visit the Emdeon website
at http://www.emdeon.com/5010/
for further information. HP
Administrative Services, LLC is
not accepting claims for testing
compliance from providers as they
are testing directly with Emdeon.
As January 1, 2012 approaches,
OSEEGIB would like to remind
providers that all electronic
transactions must conform to these
new standards. Claims that are not
in compliance will be rejected or
denied.
In order to make this change
to HIPAA 5010 standards go as
smoothly as possible, we strongly
recommend each provider work
with their claims clearinghouse
and software vendors to ensure that
their systems will be in compliance
on January 1, 2012.
In response to requests
from our Network Providers,
HealthChoice and DOC have
modified their online fee schedule
search to include historical
information for each procedure
code. Once you’ve completed a
search, click View History to view
the historical information.
Please send email inquiries
to oseegibproviderrelations@
sib.ok.gov or contact a Provider
Relations Specialist. See Network
Provider Contact Information on
the back page.
Fee Schedule
Search Modified to
Include History
Correction!
Fee Schedule for
Services When the
Patient is Not Present
CPT Code 99308 (subsequent
nursing facility care; per day for
evaluation and management of
patient) was listed in error in a
recent article about this Plan’s
coverage for services when the
patient is not present. This article
appeared in the summer edition of
our provider newsletter, Network
News, and also on our website.
Please excuse our mistake as CPT
Code 99308 is a covered service.
For a list of CPT Codes that
are not covered when the patient is
not present, go to the HealthChoice
website at www.sib.ok.gov/
providers or the DOC website at
https://gateway.sib.ok.gov/DOC
and click on the link contained in
the corrected article.
CPT Category II
Codes (F Codes)
Effective for charges incurred
on or after January 1, 2012,
HealthChoice and DOC will
recognize Category II Codes (F
Codes) only for reporting purposes.
Procedures and/or services
reported using these codes are not
covered and are not eligible for
reimbursement.
If you have questions regarding
this issue, contact HealthChoice
or DOC Provider Relations.
See Network Provider Contact
Information on the back page.
Email inquiries can be sent to
oseegibproviderrelations@sib.
ok.gov.
Mental Health/Substance Use Disorder Limits Removed
5
HealthChoice is removing the limits on the duration of treatment for inpatient and outpatient mental health
and substance use disorder. The chart below compares the Plan’s current benefits to the benefits that will be
effective January 1, 2012:
Mental Health
and Substance Use
Disorder Treatment
2011 Benefits 2012 Benefits
Inpatient Treatment
Including day treatment and
residential treatment
Limited to 30 days per calendar
year*; certification is required
Certification is required
Outpatient Treatment
Limited to 26 visits per calendar
year*; certification is required after
15 visits
Certification is required after 15
visits
Although the limits to the duration of treatment are being removed, providers will still need to follow
HealthChoice certification procedures as described below:
Inpatient treatment must be certified within 3 working days of a scheduled hospital admission, or within
1 working day following an emergency admission. To request certification for an inpatient admission, contact
APS Healthcare toll-free at 1-800-848-8121.
Outpatient treatment must be certified for medical necessity when visits exceed 15 per calendar year. To
request certification for outpatient treatment, contact the HealthChoice Health Care Management Division at
1-405-717-8879 or toll-free 1-800-543-6044, ext. 8879.
For additional information regarding the certification process, reference the Utilization Review section of the
HealthChoice Network Provider Manual which is available on the HealthChoice provider website at www.sib.
ok.gov/providers, or contact Provider Relations. See Network Provider Contact Information on the back page.
*Exceptions to the current 30-day limit are made for the diagnoses of schizophrenia, bipolar disorder/manic-depressive
illnesses, major depressive disorder, panic disorder, obsessive-compulsive disorder, and schizo-affective
disorder.
Sclerotherapy Not a Covered Benefit
Beginning with charges incurred on or after February 1, 2012, the HealthChoice fee schedule will show
sclerotherapy as NC (Not Covered).
Sclerotherapy is considered cosmetic and is not covered by HealthChoice. The following CPT Codes will
show NC status:
CPT Code Descriptions Allowables
36468 Single or multiple injections of sclerosing solutions;
spider veins (telangiectasia); limb or trunk NC
36470 Injection of sclerosing solution; single vein NC
36471 Injection of sclerosing solution; multiple veins, same
leg NC
Saphenous Vein Ablation-Laser and Radiofrequency will continue to be covered procedures; however,
certification is required.
Please email questions to HealthChoice Provider Relations at oseegibproviderrelations@sib.ok.gov or
contact a Provider Relations specialist. See Network Provider Contact Information on the back page.
New Coverage for Non-Network Emergency Room Services
6
Effective for charges incurred on or after January 1, 2012, HealthChoice will reimburse all emergency
room services based on Network benefits. The Network benefits for HealthChoice Network Facilities will apply
regardless of whether or not a facility is contracted with HealthChoice. All ancillary services provided in an
emergency room that occur on the same date of service will also be reimbursed according to Network benefits.
To be reimbursed at the Network rate, non-Network facilities must submit claims using Place of Service
Code 23. Facilities need to be aware that the $100 emergency room deductible will continue to apply to
emergency room services when the patient is not admitted to the hospital.
Following are the Revenue Codes that will be affected by the new reimbursement criteria:
Revenue
Codes
Descriptions
450 Emergency Room
451 Emergency Room: ER/Emergency Medical Treatment and Active Labor Act
(EMTALA)
452 Emergency Room: ER/Beyond EMTALA
456 Emergency Room: Urgent Care
459 Emergency Room: Other Emergency Room
Note: All codes are subject to change.
Please email questions to HealthChoice Provider Relations at oseegibproviderrelations@sib.ok.gov or
contact a Provider Relations specialist. See Network Provider Contact Information on the back page.
FaxBack Feature for Providers
HealthChoice providers now have the ability to immediately receive current plan information as well as
member eligibility, deductible, and out-of-pocket limit information by fax. This new option is available through
FaxBack. FaxBack allows you to enter your fax number and request information be faxed directly to your
office.
FaxBack documents include:
yy A Summary of Benefits for the member’s plan
yy Accumulators for the member’s plan
yy Certification requirements
FaxBack is available 24 hours a day, 7 days a week.
To access FaxBack, contact HP customer service at 1-405-416-1800 or toll-free 1-800-782-5218 and follow
the prompts of the automated system.
Please have the following information available before placing your call:
yy Your 10-digit NPI number or 9-digit social security number
yy Your fax number
yy Member’s identification number
yy Member’s date of birth
We hope our providers will find FaxBack an easy to use, convenient method for obtaining HealthChoice
member information.
Fee Schedule
Updates
HealthChoice and the
Department of Corrections (DOC)
have updated MS-DRG, MS-DRG
LTCH, and outpatient fee
schedules. Changes are effective
for charges incurred on or after
October 1, 2011.
The CPT/HCPCS, ASC,
ASA, and ADA fee schedules
for HealthChoice and DOC have
been updated and changes will be
effective for charges incurred on or
after January 1, 2012.
Be aware that HealthChoice
and DOC update the CPT/HCPCS,
outpatient hospital, ASC, ASA, and
ADA fee schedules quarterly.
The American Medical
Association may periodically
change, add, or delete procedure
codes throughout the year.
When these modifications occur,
HealthChoice and DOC will review
its fee schedule as soon as possible
and make any necessary changes.
Fee schedule updates are
reported in each issue of this
newsletter, which is distributed
quarterly to Network Providers.
Updates are also posted to the
provider websites. We encourage
you and your staff to reference the
website for
each Network
for the most
recent fee
schedule
updates
and other
important information.
If you have questions, you are
welcome to contact the Provider
Relations Division. See Network
Provider Contact Information on
the back page.
Fee Schedule Changes for Sealants
and Preventive Resin Restorations
Effective for charges incurred on or after April 1, 2012, the Allowed
Charges for sealant – one tooth (D1351) and preventive resin restoration
(D1352) will be revised as indicated below:
CDT Code Description Allowable
Charge
D1351 Sealant – per tooth $31.00
D1352
Preventive resin restoration in
a moderate to high caries risk
patient-permanent tooth
$46.00
Additionally, coverage for preventive resin restoration will be
restricted to only permanent teeth; however, there will be no restrictions
regarding the age of the patient.
Please email questions to HealthChoice Provider Relations at
oseegibproviderrelations@sib.ok.gov or contact a Provider Relations
specialist. See Network Provider Contact Information on the back page.
Providers May Want
to Join DOC Network
Due to DOC Fee
Schedule Mandate
Senate Bill 180 was recently
signed into law by Governor Fallin.
The bill mandates a change to
the fee schedule for non-Network
providers who provide services to
Department of Corrections (DOC)
inmates. Effective for charges
incurred on or after November 1,
2011, DOC non-Network providers
will be subject to the current
Medicaid fee schedule. The DOC
reimbursement rates for Network
Providers are greater than the
current Oklahoma Medicaid fee
schedule.
If you have questions about
the DOC fee schedule and how
to become a Network Provider
for DOC, please contact the
Provider Relations Division.
See Network Provider Contact
Information on the back page or
email DOCProviderRelations@
sib.ok.gov.
Post Treatment, Breast
Symmetry Surgery
Effective for charges incurred
on or after January 1, 2012,
HealthChoice will cover post
treatment, breast symmetry surgery
following breast-conserving
surgery (lumpectomy) when
the lumpectomy is medically
necessary. All surgeries for post
treatment, breast symmetry surgery
must be certified through APS
Healthcare.
Photographs
must be
submitted for
review.
If you
have questions about this new
coverage, please contact the
Provider Relations Division at
1-405-717-8790 or toll-free 1-800-
543-6044.
To certify a procedure, contact
APS Healthcare toll-free at 1-800-
848-8121.
7
Home Health Care Services
Effective for charges incurred on or after January 1, 2012, the following HCPCS procedure codes will
not be covered when services are provided in an office or outpatient setting:
HCPCS
Code Description
G0151 Physical therapist in home health or hospice setting; each 15 minutes
G0152 Occupational therapist in home health or hospice setting; each 15 minutes
G0153 Speech/language pathologist in home health or hospice setting; each 15 minutes
G0154 Skilled nurse in home health or hospice setting; each 15 minutes
G0155 Clinical social worker in home health or hospice setting; each 15 minutes
G0156 Home health or hospice aide in home health or hospice setting; each 15 minutes
S0274 Nurse practitioner visit at member’s house, outside of a capitation arrangement
One CPT/HCPCS code will be allowed per home health care provider per day for the following codes
when services are provided in an office or outpatient setting:
CPT/HCPCS
Code Description
99500 Home visit for prenatal monitoring and assessment to include fetal heart rate, non-stress test,
uterine monitoring, and gestational diabetes monitoring
99501 Home visit for postnatal assessment and follow-up care
99502 Home visit for newborn care and assessment
99503 Home visit for respiratory therapy care (e.g., bronchodilator, oxygen therapy, respiratory
assessment, apnea evaluation)
99504 Home visit for mechanical ventilation care
99505 Home visit for stoma care and maintenance including colostomy and cystostomy
99506 Home visit for intramuscular injections
99507 Home visit for care and maintenance of catheter(s) (e.g., urinary, drainage, and enteral)
99509 Home visit for assistance with activities of daily living and personal care
99510 Home visit for individual, family, or marriage counseling
99511 Home visit for fecal impaction management and enema administration
99512 Home visit for hemodialysis
99600 Unlisted home visit service or procedure
99601 Home infusion/specialty drug administration, per visit (up to 2 hours)
S5522 Home infusion therapy, insertion of peripherally inserted central venous catheter (PCC),
nursing services only (no supplies or catheter included)
S5523 Home infusion therapy, insertion of midline venous catheter, nursing services only (no
supplies or catheter included)
S9097 Home visit for wound care
S9098 Home visit, phototherapy services (e.g. Bil-lite), including equipment rental, nursing services,
blood draw, supplies, and other services, per diem
S9122 Home health aide or certified nurse assistant, providing care in the home, per hour
S9123 Nursing care, in the home, by registered nurse, per hour
S9124 Nursing care, in the home, by licensed practical nurse, per hour continued on next page
8
9
Changes to the Certification List for 2012
For charges incurred on or after January 1, 2012, HealthChoice is
making some changes to its current list of procedures and/or services that
require certification.
The following will be added to the list of services requiring
certification:
yy Spinal Cord Stimulator Placement Surgery (CPT Codes 63650,
63655, 63661, 63662, 63663, 63664, 63685 and 63688, and
HCPCS Codes L8682, L8685, L8686, L8687 and L8688)
The following will be removed from the list of services requiring
certification:
yy PET Scans for Tumor Imaging (CPT Codes 78811, 78812, 78813,
78814, 78815 and 78816)
yy Speech Therapy for plan members and their covered dependents
18 years of age or older (CPT Codes 92507 and 92508, and
HCPCS Codes S9128 and S9152)
yy Xolair Injection, omalizumab 5mg (J Code J2357)
Note: All CPT/HCPCS codes are subject to change.
Please direct questions about the certification process to the
HealthChoice Provider Relations Division at 1-405-717-8790 or toll-free
1-800-543-6044. Questions can also be sent to Provider Relations by
email to oseegibproviderrelations@sib.ok.gov.
Department of
Rehabilitation Services
Recruiting Providers
The Department of
Rehabilitation Services (DRS)
is in the process of recruiting
providers for its Network. DRS
is the state agency that provides
vocational rehabilitation to disabled
individuals to help them become
more independent, productive
members of the Oklahoma
workforce.
If you are interested in learning
more about DRS, please visit the
DRS Network Provider website at
https://gateway.sib.ok.gov/DRS.
To access the DRS fee schedule,
simply click Fee Schedule in the
top menu bar.
If you are interested in joining
the DRS Network, contracts are
available under the Contracts tab in
the top menu bar.
Please send email inquiries to
DRSProviderRelations@sib.ok.gov
or contact DRS Provider Relations
at 1-405-717-8921 or toll-free
1-888-835-6919.
Benlysta® Treatment Requires Certification
Benlysta® (belimumab) is a new intravenous medication used to treat
lupus in adults. HealthChoice requires providers to obtain certification
through its Health Care Management Division before beginning treatment
with this medication.
To certify treatment with this medication, providers must complete
and submit a Benlysta® Request Form for approval. This form is
available on the provider website at www.sib.ok.gov/providers.
S9125 Respite care, in the home, per diem
S9126 Hospice care, in the home, per diem
S9127 Social work visit, in the home, per diem
S9128 Speech therapy, in the home, per diem
S9129 Occupational therapy, in the home, per diem
S9131 Physical therapy, in the home, per diem
Units billed will be allowed for the following code when services are provided in an office or outpatient
setting:
CPT Code Description
99602 Home infusion/specialty drug administration, per visit (up to 2 hours) each additional hour
Note: All CPT/HCPCS codes are subject to change.
Certification for home health care services is required through the HealthChoice Health Care Management
Division. See Network Provider Contact Information on the back page.
If you have questions regarding this issue, contact HealthChoice Provider Relations. See Network Provider
Contact Information on the back
page.
continued from previous page
10
HealthChoice, DOC, DRS to Adopt Electronic Claims Payments
As mandated by HB1086, the
Transparency, Accountability and
Innovation in Oklahoma State
Government 2.0 Act of 2011, all
payments disbursed by the Office
of the State Treasurer must be
made solely through electronic
funds transfer (EFT).
Effective July 1, 2012, any
provider who has not authorized
EFT for their contract will be at
risk for delayed claims payments.
EFT is fast and secure, and
reimbursements are deposited
directly to the bank account you
designate. You will continue to
receive paper remittance advices
(RAs) to assist with accounts
reconciliation.
Practice groups that use the
same bank account for multiple
providers under the same TIN
need to submit only one form to
OSEEGIB along with a list of their
affiliated providers.
The HealthChoice, DOC, and
DRS electronic funds transfer and
online RA programs offer these
advantages:
yy Claim payments are
automatically deposited
yy RAs can be searched online
through ClaimLink
yy Access to current and
historical RAs through
ClaimLink
yy Less paper handling
All you have to do is complete
the form and return it to OSEEGIB
as indicated. We will take care of
the rest. Enhance your cash flow
management and sign up today
for EFT!
The EFT Authorization Form
is available from the following
websites:
yy http://www.ok.gov/sib/
Providers/Provider_Forms/
index.html
yy https://gateway.sib.ok.gov/
DOC/Forms.aspx
yy https://gateway.sib.ok.gov/
drs/Forms.aspx
You’ll need to allow two to four
weeks for your registration to be
processed, so don’t wait until the
last minute to sign up!
If you have any questions,
please contact Provider Relations at
1-405-717-8790 or toll-free 1-800-
543-6044, or send email inquiries
to oseegibproviderrelations@sib.
ok.gov.
New! Provider Applications Can Be Completed Online
Providers now have the
ability to complete and submit the
HealthChoice, DOC, and DRS
Network Provider Applications
online. In order to submit an
application online, you must have
the ability to email an electronic
signature to HealthChoice Provider
Relations.
If you don’t have an
electronic signature, the
Health Insurance
Prospective Payment
System
HealthChoice will accept
Health Insurance Prospective
Payment System (HIPPS) Codes
effective February 1, 2012. These
HIPPS Codes will be recorded for
reporting purposes only.
Please direct email inquiries
to oseegibproviderrelations@
sib.ok.gov or contact Provider
Relations. See Network Provider
Contact Information on the back
page.
application can be completed,
scanned, and then emailed to
OSEEGIBproviderrelations@sib.
ok.gov. If this is not an option for
you, complete the application and
mail it to:
HealthChoice Provider
Relations Division
3545 NW 58 Street, Suite 110
Oklahoma City, OK 73112
Or fax your application to
1-405-717-8977.
If you have questions or need
more information, please contact
HealthChoice Provider Relations.
See Network Provider Contact
Information on the back page.
Timely Claims-Filing Deadline
Waived for Coordination of Benefits
For charges incurred on or after February 1, 2012, HealthChoice will
waive the timely claims-filing deadline as it applies to Coordination of
Benefits for providers who file standard HIPAA 837 claims.
Please email questions to HealthChoice Provider Relations at
oseegibproviderrelations@sib.ok.gov or contact HP Administrative
Services, LLC at 1-405-416-1800 or toll-free 1-800-782-5218.
11
Medications Now Available in Generic Form
New generic medications are now available for the brand-name medications listed below. If you prescribe
any of these brand-name medications to HealthChoice members, please note that the generic medication
saves them money at the pharmacy. This applies to all HealthChoice members, including all members of the
HealthChoice Medicare Supplement Plans With and Without Part D.
Brand-Name
Medication
Generic Medication Treatment
Launch
Date
Alsuma sumatriptan injection Migraine/cluster
headaches Aug 2011
Amrix cyclobenzaprine HCL extended-release
capsules Muscle relaxant May 2011
Aromasin exemestane Breast cancer Apr 2011
Carbatrol carbamazepine Epilepsy or nerve pain May 2011
Concerta methylphenidate hydrochloride
extended release tablets ADHD May 2011
Elestat Ophthalmic epinastine HCL ophthalmic solution Allergic conjunctivitis May 2011
Femara letrozole 2.5mg tablets Breast cancer Apr 2011
Femcon Fe norethindrone and ethinyl estradiol Birth control Apr 2011
FemHrt 1-5 ethinyl estradiol and norethindrone Hormone replacement Feb 2011
Furadantin Suspension nitrofurantoin Antibiotic - urinary tract
infection June 2011
Levaquin levofloxacin Antibiotic June 2011
Lotrel 5/40 & 10/40mg amlodipine besylate/benazepril HCL Hypertension Jan 2011
Lybrel levonorgestrel and ethinyl estradiol Birth control June 2011
Nasacort AQ triamcinolone acetonide Nasal allergy symptoms June 2011
Nitrolingual Pump Spray glyceryl trinitrate Heart (blood flow) Mar 2011
Prenate Essential PNV with CA#68/Iron Pregnancy – nutritional
supplement June 2011
PreNexa PNV66/iron fumarate Pregnancy – nutritional
supplement June 2011
Rythmol SR propafenone SR 225mg, 325mg,
425mg capsules Abnormal heart rhythm Jan 2011
Seasonique ethinyl estradiol & levonorgestrel Birth control Aug 2011
Sular 8.5m 17, 25.5 &
34mg nisoldipine High blood pressure Jan 2011
Uroxatral alfuzosin hydrocholoride Benign prostatic
hyperplasia July 2011
Vfend voriconazole 50 & 20mg Serious fungal infections Feb 2011
Xalatan latanoprost ophthalmic solution Glaucoma Mar 2011
This publication is printed by the Oklahoma State and Education Employees Group Insurance Board, a division of the Office of State Finance as authorized by 74 O.S. , Section 1301. 4,000 copies have been printed at a
cost of $0.35 each. Copies have been deposited with Publications Clearinghouse of the Oklahoma Department of Libraries.
He lthChoice Provider
Network News
3545 NW 58 Street, Suite 110
Oklahoma City, OK 73112
www.sib.ok.gov
www.healthchoiceok.com
Presorted
First-Class
U. S. Postage
PAID
Permit #1067
Okla. City, OK
Network Provider Contact Information
DOC Provider Relations
https://gateway.sib.ok.gov/DOC
OKC Area 1-405-717-8750
Toll-free 1-866-573-8462
DOC Health and Dental Claims
HP Administrative Services, LLC
P. O. Box 268928
Oklahoma City, OK 73126-8928
Toll-free 1-800-262-7683
DRS Provider Relations
https://gateway.sib.ok.gov/DRS
OKC Area 1-405-717-8921
Toll-free 1-888-835-6919
DRS Health and Dental Claims
HP Administrative Services, LLC
P.O. Box 25069
Oklahoma City, OK 73125-0069
Toll-free 1-800-944-7938
HealthChoice Providers
www.sib.ok.gov
www.healthchoiceok.com
Health and Dental Claims
HP Administrative Services, LLC
P.O. Box 24870
Oklahoma City, OK 73124-0870
Customer Service and Claims
OKC Area 1-405-416-1800
Toll-free 1-800-782-5218
FAX 1-405-416-1790
TDD 1-405-416-1525
Toll-free TDD 1-800-941-2160
Pharmacy
Medco Health Solutions
Pharmacy Prior Authorization for
Preferred/Non-Preferred or
Brand/Generic
Toll-free 1-800-841-5409
Other Pharmacy Prior Authorization
Toll-free 1-800-753-2851
Certification
APS Healthcare
P.O. Box 700005
Oklahoma City, OK 73107-0005
Toll-free 1-800-848-8121
Toll-free TDD 1-877-267-6367
FAX 1-405-416-1755
HealthChoice Health Care
Management Division
OKC Area 1-405-717-8879
Toll-free 1-800-543-6044
Ext. 8879
HealthChoice Provider
Relations
OKC Area 1-405-717-8790
Toll-free 1-800-543-6044