You may verify the current billing address on record for your contract at the HealthChoice Provider Self Service web page - https://gatway.sib.ok.gov/providerselfservice.
If the address listed does not exactly match the address you are now billing under, your claims will be paid as non-network. To update the billing address on record for your contract, you should submit a completed Change Form with the correct information.
The Change Form is available for download on the HealthChoice provider website at - http://www.sib.ok.gov/providers/Providers_Forms.asp.
Please submit your completed Change Form to Provider Relations either by email, mail, or by fax:
Via Email
oseegibproviderrelations@sib.ok.gov
Via Mail
HealthChoice
Attn: Provider Relations
3545 NW 58th, Suite 110
Oklahoma City, OK 73112
Via Fax Fax: 1-405-717-8977
OSEEGIB hereby clarifies the intent of Network Provider contract articles relating to certification/ utilization review requirements:
Effective January 1, 2010, as soon as an outpatient procedure or inpatient admission has been certified and approved, the provider has met the conditions of the contract, and the procedure can be performed immediately. It will not be necessary to wait the three-day period before services may be provided.
CPT and HCPCS codes will be added to the HealthChoice and DOC fee schedules effective 11-1-09 for the H1N1 Virus vaccine and its administration. These three codes are as follows:
As a reminder, the Utilization Review section of the Network Provider contract mandates that certification/authorization must be obtained before some specific services are rendered or the claims submitted for those services will be denied. If certification/authorization is subsequently obtained and medical necessity is established, a 10% penalty will be applied to the payment.
If you need additional information or you have questions, please contact Provider Relations at 1-405-717-8790 or toll free 1-800-543-6044.
The Ambulatory Surgery Center Fee Schedule will be updated effective January 1, 2010. The updated CPT/HCPCS, Outpatient Facility, and Ambulatory Surgery Center fee schedules will be made available to providers before January 1st on this web page.
The allowable for CPT code 41899 has been updated to $1,566 in an Ambulatory Surgery Center setting. The original fee schedule amount of $80 was not appropriate and we are taking this opportunity to correct the previous fee allowed by the Plan. The fee schedule that is included in the ASC contract (See Contracts/Appl in the menu at left) has also been updated to reflect the most current allowable for code 41899.
In addition to updating the fee schedule, claims reimbursed at the erroneous fee will be adjusted to allow the revised fee schedule. Do not send any claims for adjustment. The claims will be adjusted automatically. You will be notified of the adjustment through your remittance advise statements.
In an effort to increase the efficiency and accuracy of claims processing, effective September 1, 2009, non-standard claims will no longer be accepted. All claims that are not submitted on the proper claim form, or forms that are incomplete, will be returned. Inappropriate claim forms include, but are not limited to superbills, copies of receipts, or printed reports generated from practice management software.
Visit the following web sites to access the appropriate claim forms or for more information on proper billing procedures.
Claim forms sent by FAX will no longer be accepted.
Although the transition from the previous claims administrator to EDS has been extremely difficult, there has been significant improvement with claims payment. Now, more than 70% of electronic claims are processed within one business day. However, much improvement is still needed in regards to the customer service being provided to HealthChoice members and providers. The extremely long hold times members and providers are experiencing when attempting to call EDS does not meet the requirements stipulated in its contract with HealthChoice. EDS has hired additional customer service representatives in an effort to reduce the hold time. HealthChoice will continue to monitor EDS’s progress in this area and apply financial penalties appropriately until it is in compliance with the contract.
For assistance with any outstanding claim issues, you can send an email containing the details of your issue to EDSResolution@sib.ok.gov. For security reasons, please include the member ID number in your email instead of the member's Social Security number.
The FHH overpayments that were scheduled to be recouped from claim payments starting 9/1/09 have been delayed until 1/1/10.
Providers were notified of these overpayments by FHH at the end of 2008 via refund request letters and were given 60 days to dispute the requests at that time. Providers who have unresolved overpayment issues from FHH should contact EDS immediately and provide any supportive documentation regarding their concerns.
Contact EDS customer service at 1-405-416-1800 or toll-free 1-800-782-5218.
We regret that there has been some confusion regarding certain HealthChoice dental benefits. We hope this will provide some clarification.
Dental Prophylaxis Coverage
HealthChoice covers dental prophylaxis treatments for children 0-12 years old (ADA code D1120) and for members 13 years of age and older (ADA code D1100). Two prophylaxis treatments are allowed per calendar year. All prophylaxis treatments must be billed on an 2006 ADA Dental Claim Form.
Coverage for Bitewing X-Rays
HealthChoice currently covers up to four bitewing x-rays per calendar year. The cost for bitewing x-ray services in excess of the maximum benefit , are the responsibility of the member.
The following codes are assigned by the American Dental Association for bitewing x-rays in its current Dental Terminology Code Book 2009-2010. All claims must be filed on an 2006 ADA Dental Claim Form:
D0274 – 4 bitewings
D0273 – 3 bitewings
D0272 – 2 bitewings
D0270 – 1 bitewing
The previous dental administrator applied this benefit, incorrectly, allowing eight bitewing x-rays per calendar year. Due to the initial confusion regarding the benefit for bitewing x-rays, HealthChoice continued to allow eight bitewings per calendar year for charges incurred before January 1, 2009.
HealthChoice has clarified this benefit discrepancy with the current dental administrator, EDS Administrative Services, and effective for charges incurred on or after January 1, 2009, the correct benefit of four bitewings per calendar year is being applied by EDS.
An article that sought to clarify the issue of coverage for bitewing x-rays appeared on the front page of the Spring Edition of the HealthChoice Provider newsletter, the Network News. The newsletter was mailed to all Network Providers in March of this year.
Fluoride Treatment Coverage
OSEEGIB covers fluoride treatments for children ages 0-15 (ADA code D1203). There is a limit of two fluoride treatment allowed per calendar year. Adult fluoride treatments (ADA code D1204) are not a covered benefit. All fluoride treatments must be billed on an 2006 ADA Dental Claim Form.
For Faster Processing of Dental Claims
For faster service for you, as a dental provider, please do not send things such as dental x-rays and molds with the claim or dental pre-determination unless they are requested by HealthChoice. This will also save you time and expense. EDS, the dental claims processing administrator, currently receives many dental items that are not necessary for claims payment.
Oklahoma State Statutes require interest to be paid to providers when clean claims are not processed within 45 days of receipt. In accordance with this requirement, the Oklahoma State and Education Employees Group Insurance Board, through its third party claims administrator, EDS Administrative Services, is paying interest for claims that meet the criteria required in the State Statues.
Prospective interest payments began on April 8, 2009. All claims paid on or after that date included interest payments if the claim was not processed and paid within the mandated 45 day period.
Recently, retrospective interest payments were initiated. Providers were sent communication through the mail with instructions on how to initiate the process of receiving interest for older claims. The process of distributing retrospective interest is being handled in three phases.
Questions and Answers regarding interest payments can be found using the Interest Payment Questions and Answers link following this article.
Any additional questions you may have concerning interest payments should be directed to EDS Administrative Services at 1-405-416-1780 or toll-free 1-800-782-5218.
Interest Payment Questions and AnswersOrthodontic Services are paid by the Plan at the established benefit level when the banding has been performed. The orthodontist is expected to file a claim for the services performed at the time the service is rendered. The Plan does not pay claims based on payment installments.
A small percentage of Orthodontists are filing claims with future billing dates. Claims with future billing dates will not be accepted and will be denied.
If you have any questions regarding the processing and payment of claims for orthodontic services, please contact EDS Administrative Services customer service at 1-405-416-1800 or toll free 1-800-782-5218.
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