2024 Summer Network News

• Corrected claims
• Durable medical equipment brace policy
• HealthChoice payment process
• HealthChoice contracts and applications
• Payment methods
• Billing for DOC inmates
  
• DRS billing
• Medical rehabilitation reimbursement
• Fee schedule updates
• HealthChoice contact information

You should only submit a corrected claim when changing the following fields within a claim form: 

• Units.
• Diagnosis code (records may be needed to support an updated diagnosis code).
• Place of service (POS).
• Date of service (DOS).
• Type of bill (TOB).
• Lines that have been added or removed.
• DRG.
• Provider name.
• NPI.
• TIN.
• Updates to the service or billing address.
• Billed amount.
• CPT/HCPCS changes.
• Revenue code changes.
• Modifier adds/removes/changes (records may be needed to support any change).

You should submit a void request for the following: 

• A new claim submission on a different claim type (UB to HCFA or HCFA to UB).
• Patient name change.
• Member ID number change.
• Group number change.

If any other information needs to be changed within the claim, please void the original claim and file a new claim. This will ensure that the claim does not deny as a duplicate. 

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

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HealthChoice may allow up to a maximum of two braces for the same injury or occurrence. An additional two braces may be allowed if a new or additional injury occurs. For example, if a member injures their right ACL, HealthChoice may allow up to two braces for this distinct injury. If the member later injures their right MCL, HealthChoice may allow up to two braces for this injury. If the member later reinjures their right ACL, HealthChoice may allow up to two braces for this new occurrence. Medical necessity requirements and certification requirements apply.

Unloading knee braces and other supportive devices are not covered for the treatment of osteoarthritis or degenerative joint disease unless there is an associated injury or surgical procedure.

Documentation with the date of the new injury may be required to complete the review for the additional brace(s).

Review the HealthChoice fee schedules to determine if certification is necessary. Certification can be initiated through the Provider Portal. You can also check certification status, upload any necessary records, view the original submission or initiate a preservice appeal. Additional information on certification is located in the Policies and Guidelines section of the HealthChoice provider site. 

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

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The claims administrator processes HealthChoice claims daily and offers several different methods of reimbursement to select from, each with their own processing timeline.

Direct deposit can be the fastest method to receive reimbursement and ensures that there are no lost payments, and payments are viewable through the Optum Pay web portal. Providers can enroll online for direct deposit through Optum Financial. EFT funds are sent via automated clearing house (ACH) and typically are available three business days after the payment has been issued.

If already enrolled with Optum Financial for ACH direct deposit pay, you have the option to switch your method of payment to virtual credit card (VCP). VCP payments are loaded onto a virtual card and processed by using your point-of-sale credit card terminal. VCP payments are typically available six days after payment is issued if you have elected fax or nine days after if you elected email delivery. Note: If you do not redeem the VCP payment within 30 days, Optum Financial will void the virtual card payment and issue you a paper check.

If you elect to not enroll with Optum Financial, you will receive payment by paper check. Paper checks are typically mailed five days after payment has been issued. You should also allow additional time for the paper check to be delivered to your office or post office box. If you don’t receive your paper check within 30 days of your claim being processed, contact Customer Care for a check to be reissued.

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

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HealthChoice only accepts the most current version of the contract and application and forms, located on the HealthChoice Providers webpage.

Complete and return the most appropriate contract and application, along with the required attachments, when adding a new TIN to EGID Network Management. HealthChoice accepts digital and e-signatures on all documents.

For questions or further information, email EGID Network Management or call 405-717-8790 or toll-free 844-804-2642. TTY users call 711.

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The claims administrator offers several different methods of reimbursement to select from, each with their own processing timeline.

To receive payment via direct deposit, we encourage you to enroll online with Optum Financial, a multi-payer platform, or by calling 877-620-6194. Enrolling in direct deposit assures that there are no lost payments, and payments are viewable through the Optum Pay web portal. There is often less administrative cost with receiving electronic payments.

To complete online enrollment, you need:

• Organization name, mailing address and tax identification number (TIN).
• Contact information.
• Organization’s banking information, if selecting direct deposit.
• Organization’s W-9 form.
• A voided check or bank letter for each account where payments will be deposited.

If already enrolled with Optum Financial for direct deposit, you have the option to switch your method of payment to virtual credit card (VCP). VCP payments are loaded onto a virtual card and are processed by using your point-of-sale credit card terminal. While no banking information is required for this payment option, there may be additional terms and conditions, including fees from your card service processor. If selecting VCP, you will receive a notification with a card number that can be loaded into your credit card terminal. VCP information is sent via mail or fax. Allow additional time if the VCP information is being mailed. Once the VCP information has been run using your point-of-sale credit card terminal, your payment will settle in your bank account according to your credit card merchant agreement.

If you elect to not enroll with Optum Financial, you will receive payment by paper check. You should expect additional time for the paper check to be delivered to your office or P.O. Box. If you don’t receive your paper check within 30 days of your claim being processed, contact Customer Care for a check to be reissued.

For questions about payment methods, call Customer Care at toll-free 800-323-4314. TTY users call 711.

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To be reimbursed for medical or dental services provided to DOC inmates, you must bill the Department of Corrections within 120 days of providing services and adhere to following the directions below.

You may file claims electronically with payer ID 71065, through the provider portal (you can upload a claim with PCH or you can manually key a claim with iEDI), or mail paper claims to DOC Claims, P.O. Box 30522, Salt Lake City, UT 84130-0522.

• Bill with group number 76415170.
• Add the prefix 365000 to the DOC inmate ID number if it is 6 digits.
• Add the prefix 36500 to the DOC inmate ID number if it is 7 digits.
• Enter the updated prefix + digit DOC inmate ID number when making a DOC inquiry using the IVR system or provider portal.

The updated DOC inmate ID number, after adding the prefix, should always be 12 digits. To verify the DOC inmate ID number, visit https://okoffender.doc.ok.gov/.

You cannot invoice or balance bill the inmate for reimbursement. Invoices received by DOC or the inmate will be disregarded. DOC claims are paid at 100% of the fee schedule allowable. You can view allowable amounts for DOC claims by logging into the DOC Fee Schedule.

For questions, call the Customer Care team at toll-free 800-323-3710. TTY users call 711.

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You must file claims using industry-standard formats to be reimbursed for services performed on behalf of the Department of Rehabilitation Services. The claims administrator offers several different methods of claims submission:

• Electronically file claims with payer ID 71065.
• Direct data entry of medical claims is available through Optum Intelligent EDI (iEDI), available for free, to enter claims directly online, through the portal. DentalXChange is available for the direct data entry of dental claims.
• Upload claim images through the portal.
• Mail paper claims to DRS, P.O. Box 30521, Salt Lake City, UT 84130-0521.

You must use the group number 76415171 and include the members social security number in the insured’s I.D. number field on the claim form. Claims should be submitted on an appropriate claim form with all required fields completed and legible. Timely filing limits require the claim to be filed within 180 days of the date of service.

For general questions, call Customer Care at toll-free 800-285-6815. TTY users call 711.

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Our intent is to process inpatient medical rehabilitation (revenue codes 01x8) based on the Revenue fee schedule, using a per diem methodology. View reimbursement rates by logging in to the fee schedule portal.

For questions, email EGID Network Management or call toll-free 844-804-2642. TTY users call 711.

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