New Coverage for Non-Network Emergency Room Services
Posted 10/19/11; Modified 02/01/12
For charges incurred on or after January 1, 2012, HealthChoice began reimbursing all emergency room services based on its Network fee schedule and coinsurance level. This Network benefit applies regardless of whether or not a facility is contracted with HealthChoice. All ancillary services provided in the emergency room on the same date of service are also reimbursed based on the Network fee schedule and coinsurance level.
To be reimbursed at the Network rate, non-Network facilities must submit claims using Place of Service Code 23. Be aware that the $100 emergency room copay* continues to apply to emergency room services when the patient is not admitted to the hospital.
Following are the Revenue Codes** that are affected by the new reimbursement criteria:
|Emergency Room: ER/Emergency Medical Treatment and Active Labor Act (EMTALA)
||Emergency Room: ER/Beyond EMTALA
||Emergency Room: Urgent Care
||Emergency Room: Other Emergency Room
Please email questions to HealthChoice Network Management/Provider Relations at firstname.lastname@example.org or contact a Provider Relations specialist at 1-405-717-8790 or toll-free 1-800-543-6044.
*The emergency room copay does not apply to the Basic or Basic Alternative Plans.
**All codes are subject to change.