Frequently Asked Questions

ClaimCheck FAQs

Q: How do I submit claims electronically to HealthChoice?

A: Electronic claims can be submitted through your claims clearing house by using payer ID number 22521. This number identifies HP Administrative Services, LLC. as the HealthChoice claims administrator.

Claims can also be uploaded directly to the HP system using the standard 837 HIPAA compliant format. If you are interested in uploading claims directly, contact the HP Customer Service Call Center at 1-800-782-5218 to begin the application and testing process.

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Q: How do I submit paper claims to HealthChoice?

A: HP administers all health, dental and life claims on behalf of HealthChoice. Paper claims should be submitted to the following address:

HP Administrative Services, LLC.
P.O. Box 24870
Oklahoma City, OK 73124

Correspondence should be submitted to the following address:
HP Administrative Services, LLC.
P.O. Box 24110
Oklahoma City, OK 73124

To ensure timely claims processing, the following information must be included on a CMS-1500, UB-04, or ADA form:
 

• Patient’s name
• Primary insured’s name
• Primary insured’s ID number
• Provider’s name and tax ID number
• Provider’s billing address
• Date(s) of service
• ICD or DSM diagnosis codes
• CPT/HCPCS, DRG CDT, or ASA codes with the appropriate modifiers
• Itemized charges (also required for all outpatient hospital services). Forms must be completed as required by CMS guidelines.

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Q: Is electronic funds transfer (EFT) available through HealthChoice?

A: Yes. Only Network Providers can utilize EFT. To begin the process, complete an EFT Form and return it to HealthChoice Provider Relations. Use the following link to download the EFT form.  EFT Form

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Q: Can I get a HealthChoice fee schedule or information regarding the Plan’s Allowed Charges?

A: 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 Provider Relations Division at 1-405-717-8970 or 1-800-543-6044 toll-free and a Provider Relations Specialist will assist you.

HealthChoice Fee Schedule Search

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Q: How do I report a name/address change or a change in my tax identification number (TIN)?

A: You can print a copy of the Change Form online by clicking on Provider Forms in the Provider drop down menu. You can also contact HealthChoice Provider Relations and a Change Form will be sent to you. Please complete and return the Change Form as soon as possible preferably 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 data base will be updated and your new information will be forwarded to the HealthChoice claims administrator, HP.  The HealthChoice Provider Contract requires that all changes be reported to HealthChoice within 15 days of the date of the change.

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Q: If I have questions regarding claims I’ve submitted to HealthChoice or questions about the eligibility of a patient, who do I contact?

A: Claims and eligibility information is available online through the ClaimLink feature of our website.
If you are unable to access the information using ClaimLink, please contact HP Administrative Services, LLC., at 1-405-416-1800 or toll-free 1-800-782-5218.

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Q: How long does it take to process a Network Provider Application, and when does it become effective?

A: Generally, your Network Provider Contract will become effective within ten days of the receipt of your completed application.
If you application is incomplete, additional time will be necessary to activate your Network Provider Contract. In this case, the effective date will be ten days from the date all information has been received.

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Q: Although I’m a HealthChoice Network Provider, I had a claim that was paid as non-Network. How do I correct this? 

A: You may have made changes to your provider information that have not been reported to HealthChoice. Contact Provider Relations to verify your information or you can reference the Provider Self Service 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 or its claims administrator, please contact HP Administrative Services, LLC. at 1-405-416-1800 or toll-free 1-800-782-5218.

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Q: What if I move to another practice or provider group? 

A: You will need to submit a new application; however, the effective date of your contract will not change from the original date unless there is break in your Plan participation that lasts longer than 30 days. Use the Contracts/Appl. link to download and print the appropriate application.

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Q: How many lives are covered by HealthChoice?

A: Approximately 187,000 lives are covered under the HealthChoice Plans. HealthChoice covers active and retired state, education and local government employees and their dependents.

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Q: Does HealthChoice require Certification for certain procedures?

A: Yes. Certification is required for certain outpatient surgical and diagnostic imaging procedures which include:

Outpatient Surgical Procedures
Blepharoplasty
Rhinoplasty
Breast Implant Removal
Scar Revision
Breast Reduction
Panniculectomy
Surgical treatment of varicosities
Diagnostic Imaging Procedures
Sinus CT / MRI
Head / Brain CT / MRI
Chest CT including spiral CT (RAD)
Spine CT / MRI
Shoulder MRI
PET Scans

To request Certification, print a copy of the Certification Request Form which can be found on this website by clicking on Provider Forms in the Provider drop down menu. Please complete the form and FAX it directly to APS Healthcare.

If you’re unable to access the form from our website, please contact APS Healthcare at 1-800-848-8121 to request Certification.

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Q: How do I request Certification for other services such as Home Health Care, Hospice, and Infusion Therapy services?

A: To request Certification, print a copy of the applicable Certification Form. Please complete the form and FAX it directly to the HealthChoice Healthcare Management Division. To access the following Certification Forms, follow the links below:

Air Ambulance
Chiropractic Treatment
Durable Medical Equipment
Home Health Care
Hospice Care
Infusion Therapy
Medication or Treatment Request
Mental Health Treatment
Occupational Therapy
Osteopathic/Physical Medicine Treatment
Outpatient Chemical Dependency
Physical Therapy
Speech Therapy
Synagis Request
TMD/TMJ Authorization
Xolair Request

If you’re unable to access the form you need from our website, please contact the HealthChoice Health Care Management Division at 1-405-717-8879 or toll-free 1-800-543-6044. ext. 8879

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Q: How do I get Certification for inpatient hospital or other admissions to inpatient health care facilities?

Please contact APS Healthcare at 1-800-848-8121. HealthChoice requires that all non-emergency hospital admissions are Certified at least three working 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.

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Q: How do I get an authorization for medications that are not included on the HealthChoice Select Medication List?

A: Please contact Medco Customer Service toll-free at 1-800-903-8113 and they can assist you in seeking authorizing for a non-preferred medication.

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Q: If I don’t agree with the manner in which a particular claim was processed, what can I do? 

A: You can file an appeal with HP. If your appeal is upheld, you must contact the Provider Relations Division at 1-405-717-8970 or 1-800-543-6044 toll-free and a Provider Relations Specialist will assist you.

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