HELP Check Provider Tutorial
Welcome to the HealthChoice HELP Check Tutorial. During this tutorial, we will be reviewing the details of the HELP Check program.
This tutorial should answer questions you have about the HELP Check program.
“Let’s Get Started”
What is HELPCheck?
HELP Check is a wellness program implemented by HealthChoice. It is designed to help our members identify their health risks and take steps to improve their health.
Let’s begin with reviewing the program requirements. Eligible HealthChoice members must do the following:
- Complete their free comprehensive preventive services visit
- Complete their free comprehensive metabolic and lipid panels
- Complete their health risk assessment
Members who are Medicare primary are not eligible to participate in the HELP Check Program.
Providers will be reimbursed 100% of the Plans’ Allowed Charges if they meet the following requirements:
- Participate in the HealthChoice Provider Network,
- Provide services in an outpatient or medical setting, and
- Bill the designated CPT Codes
Helpful hint: Members are only eligible one time per calendar year for their free preventive exam. This means you will not need to collect an office visit copay.
The following CPT codes must be used when billing for the HELP Check Program:
If your patient is a new patient, you will need to bill:
New Patient – Initial Comprehensive Preventive Medicine Exam
- 99385 – patient age 18-39
- 99386 – patient age 40-64, or
- 99387 – patient age 65+ (non – Medicare)
If your patient is an established patient, you will need to bill:
Established Patient – Comprehensive Preventive Medicine Exam
- 99395 – patient age 18-39
- 99396 – patient age 40-64, or
- 99397 – patient age 65 + ( non – Medicare)
Now that we have completed reviewing the preventive exam, let’s review the required metabolic and lipid panels. The following services are covered one time per calendar year at 100% of the plans’ allowed charges, with no out-of-pocket costs to the member.
- 80053 – comprehensive metabolic panel or
- 80050 – general health panel
- 80061 – comprehensive lipid panel
Did you know – The HELP Check program designated CPT codes are covered only once per calendar year at 100% of the HealthChoice Allowed Charges, regardless of the patient’s diagnosis.
Remember, when CPT codes are covered at 100%, the member has no copay or other out-of-pocket cost.
Are you wondering what happens when other services are provided during the office visit?
Multiple procedures or codes are allowed to be billed at the same time as the free preventive exam; however, additional services outside the HELP Check program are subject to all Plan provisions including deductibles, copays, and coinsurance.
Your patient will need the following information from their preventive exam:
Biometrics Results to include:
- Height and weight,
- Blood pressure, and
- Resting heart rate
Lab Results to include:
- Fasting blood glucose
- Fasting ldl, hdl, and total cholesterol, and
- Fasting triglycerides
What you might see from our members:
- HELP Check Member Instructions
- HELP Check Questions and Answers
- HELP Check Provider Instructions
- HELP Check Provider Billing Instructions
- Easy to follow member check list
HELP Check Provider Instructions and HELP Check Provider Billing Instructions are on this website located under the provider form section.
Preventive Services are covered at 100% of Allowed Charges
Certain preventive services are now covered at 100% of the HealthChoice allowed charges. Members must meet specific criteria including age, sex, policy limits, and diagnosis and procedures codes. Eligible members have no copay or other out-of-pocket costs. A list of these preventive services, including criteria, can be found on the HealthChoice Provider web page under Quick Links.
Thank you for taking the time to review this tutorial. If you have questions or need additional information, please contact HP Administrative Services at 1-405-416-1800 or by calling toll-free 1-800-782-5218.