Claim Filing Procedures/Claim Payments
HealthChoice Network Providers are required, under the terms of the Network Provider Contract, to file claims for HealthChoice members.
Submit claims for dates of service beginning Jan. 1, 2018, and after, to:
PO Box 99011
Lubbock, TX 79490-9011
Appeals and provider inquiries should be submitted to:
PO Box 3897
Little Rock, AR 72203-3897
Acceptable claim forms are:
Regardless of the claim form utilized by the provider, claims are processed according to the appropriate fee schedule.
HealthChoice has a new provider portal, HealthChoice Connect, at www.healthchoiceconnect.com.
On this self-service portal, providers will be able to access:
- Member benefits.
- Claim status.
- Electronic payments.
- Electronic Remittance Advices in PDF.
- Direct data entry of claims.
- Direct data entry of certification requests.
When registering on HealthChoice Connect, you will need to use your contracted tax ID number and one contracted NPI number for authentication. Only one registration is required per TIN, as this will give you access to all contracted providers and NPI numbers under that TIN. Please note, the NPI number used must be an NPI number that we have associated with your TIN. For physicians/practitioners, this would be the individual NPI number.
Direct Data Entry
Within HealthChoice Connect, providers have the ability to submit individual claims without any intermediary software through the direct data entry feature. The direct data entry feature allows providers to submit individual medical, dental or hospital claims directly to the claims administrator. The provider receives an immediate response regarding the status of the claim with real time responses indicating if the claim has been paid, denied or suspended.
Electronic Claims Submissions
Providers are able to submit claims electronically through their existing clearinghouses utilizing payer ID 71064. Contact the health and dental claims administrator directly for more information.
All claims are paid directly to Network Providers as required under the terms of the contract.
HealthChoice Network Providers currently accepting Medicare assignment will receive direct claims payments.
Electronic Funds Transfer
Mandatory enrollment in the EFT and ERA programs applies to both Network and non-Network providers.
Checks and Remittance Advices are processed for Network Providers on a nightly basis. Payments are deposited into the provider’s bank account the next business day. If you have questions or you need more information about enrolling for EFT or ERA, contact ECHO Health at www.providerpayments.com.
Combined payments are utilized for all provider to the legal name and TIN. Under the combined payments feature, all payments for a given day are combined into a single payment which is issued to the provider on a daily basis. Combined payments should facilitate the processing of claim payments by the provider.
If you have questions or you need more information about combined payments, contact the ECHO Health at www.providerpayments.com.