For our Providers…
The Care Coordination program is available only to pre-Medicare former employees and surviving dependents enrolled in a HealthChoice health insurance plan, which includes approximately 8,600 lives. Members with chronic conditions can greatly benefit from this program; however, any member who needs information about a condition or assistance navigating to the right providers to meet their individual health care needs will also benefit.
How does care coordination work?
Members who have chronic conditions such as diabetes or pre-diabetes, hypertension, cardiovascular disease, asthma, COPD, hyperlipidemia, or have recently been hospitalized for any related condition are eligible to participate in the HealthChoice Care Coordination program.
Care coordinators work with providers and caregivers to develop a treatment plan effectively utilizing their benefits.
How does a provider become involved in care coordination?
If the clinical history identifies a high-risk candidate for care coordination (three or more chronic conditions mentioned above), the member will be contacted by our care coordination staff. Following an introduction and enrollment into the HealthChoice Care Coordination program, the member will be required to select a primary care physician (PCP) who will monitor their care and be a resource to ensure they get the appropriate care at the appropriate time. PCPs can be selected from any HealthChoice family practice, general practice, or internal medicine physician. The care coordinator can also assign a PCP to the member if desired and requested. The PCP will then be contacted to gain insight into the treatment plan and anticipated outcomes, with the goal of establishing a relationship that will improve access, communications and compliance.
Members can visit a participating specialist without going through their PCP, but they are encouraged to go through their PCP, if possible, to ensure the PCP is aware of the care they may need so that they can assist in coordinating that care. The member’s PCP should direct them to a network specialist in order to maximize their benefits whenever possible. This also helps prevent duplication of services.
Benefits are not impacted when members participate in the care coordination program. Members will receive information on how to better utilize their benefits working with someone to help them navigate the plan. The requirements for precertification remain the same.
The HealthChoice provider fee schedules, certification, and claims submission, and payment processes will remain in place. Contact HealthChoice for any address updates or practice changes.
Visit www.hccarecoordination.com for more information on this new program including 24/7 nurse advice line, care coordination details, frequently asked questions, health-related articles, health risk assessments and more. If you have questions, please call 405-652-1041 or 855-445-1471.